Case Study Of Ahp

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CASE STUDY: SELECTION OF BEST HOSPITAL FOR SURGERY USING AHP Article · January 2015

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CASE STUDY: SELECTION OF BEST HOSPITAL FOR SURGERY USING AHP Dr. Hima Gupta Associate Professor, Operations Management, Jaypee Institute of Information Technology (JIIT), A-10, Sector-62, Noida 201307, Uttar Pradesh, India. E-mail: [email protected]

The IUP Journal of Operations Management, Vol. XIV, No. 3, 2015 Abstract This case study describes the use of AHP in choosing a best hospital for surgery of a patient suffering from heart disease. There are several competing hospitals and various competing criterion for choosing the most suitable one. By using the AHP, the patient is able to choose the best hospital in a coherent, obvious way which can be scrutinized and understood by all concerned. This paper checks some of the useful and estimating matters concerned with the various problem of multiple criteria decision making situation and when the AHP method is used in medical applications. The AHP itself solves the difficult and complex issues with the simplified way by breaking down the whole things into smaller pieces. Key Words: Decision Making, Criteria, health care units, multi criteria analysis, strategy, pair wise comparison. Introduction A sustainable competitive advantage is achieved if a valuable strategy is implemented by any organization. Actually it is visible that the strategy formulation is totally depending upon the choice. Therefore as and when organizational environment changes, one has to always keep on changing or optimizing the alternatives once selected and ultimately it will lead to appropriate decision. The process improvement technique like Six Sigma, lean Six Sigma, Kaizen etc., does the prioritization decisions based on the method of analytic hierarchy process (AHP), and proved

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to be exceptionally helpful, because there one has to take both tangible and intangible considerations together. Measuring health care service performance is a complex task as it has multiple-functions, which contribute in aggregate towards achieving overall goals. There has been an increasing need of a tool for the process-based performance measurement of multispecialty tertiary care hospitals to identify the deficiencies in services and suggest recommendations for their improvement. Many Practical problems are successfully solved with help of Analytical Hierarchy Process (AHP) multi criteria decision making method. This method in itself has certain shortcomings and disparaged many a times for gripping the uncertainties as well as lack of ability to adequately handle the inherent uncertainty and vagueness connected with the plotting of the decision model’s perceptions to exact numbers. However, due to the complexity and uncertainty involved in real world decision problems, decision makers might be more reluctant to provide crisp judgments than fuzzy ones. Analytic Hierarchy Process (AHP) is a multiple a criteria method, is employed in this paper to develop a model for evaluating the performance of the processes involved in the health care units in India. After group discussion each step in the described model was evolved and brainstorming sessions among clinicians and managers with more than twenty years service in healthcare system. AHP is a structural technique for organizing and analyzing complex decision, based on mathematics and Psychology. The AHP presents a structure which facilitates us to make effective decisions on complex issues by simplifying and expediting our natural decision-making processes. This case study describes the use of the AHP in choosing a best HOSPITAL for surgery for a patient who is suffering from heart problem. There are several competing hospital and several

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competing criteria for choosing the most suitable one. By using the AHP, the patient is able to choose the best hospital in a rational, transparent way that can be examined and understood by all concerned.

Decision scenario Health service sector is a complex area that is unique in all its characteristics. It has too many dimensions to be fitted into a simple singular unit and it is therefore essentially very difficult to approach the measurement of the performance of healthcare services by using one method or another. The overall performance of any health care units is based on certain specific metrics, which according to the associated people assumed to be an important parameter of the performance itself. The healthcare delivery is assessed by three categories of measurement namely structure, process and outcome (Donabedian 1980). The progress report “India’s Best Hospitals” released annually by the ET News and World Report since 1990, incorporates all the three quality measures in attempting to rate the best hospitals nationwide in United States of America (US News and World Report, 1990). The structure of the hospitals is assessed by the human and material resources available in the respective hospitals. The mortality ratio, ratio of the observed to expected mortality rate in each hospital, is considered to be a indicator to judge the performance of the respective healthcare units. Process of hospitals has been difficult to measure by specific metrics. The authors of the annual progress report have acknowledged that there is inherent difficulty in measuring the process of care in hospitals (The Editors of US News and World Report, 1996). Hence they relied upon a survey involving physicians for the evaluation of the process of healthcare delivery of healthcare system. The master file of Indian Medical Association has been taken for collecting

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the data related to physicians and request them to point out the five best hospitals in their respective area. Obviously this is a highly subjective assessment because the physicians were not given any criteria to rate the hospitals. Although process was considered as the primary aspect of assessment among all the three measures of quality, there have been few methods developed so far to reliably measure the process of care in a healthcare institution. Therefore, in an attempt to measure the performance of a multi-specialty tertiary care hospital with regards to its processes of healthcare delivery, we devised a model using the Analytic Hierarchy Process (AHP), a multiple criteria decision-making technique developed initially by Saaty (Saaty, 1980). We applied this model to evaluate the performance of two hospitals in developing countries namely Barbados and India for comparing the outcomes. The hospitals picked here were having the university teaching hospitals with public sector role, with similar bed-numbers and are referral centers catering to populations of about 270,000. The health – sector in India is in deep crisis now days. The country’s performance on issues related to health is very miserable, inspite of so many initiatives taken by the government. The hard core statistics clearly indicates that the infant mortality rate is seven time of United States and three times of China. Almost two thirds of babies are born without the aid of skilled health personnel in rural India. India has 63 millions diabetics and 2.5 million cancer patients, in major cases will not treated as not diagnosed in time. It is hardly five percent of the 2.5 million Indians who need heart surgery get it on an annual basis. Though India has 750,000 doctors and 1.1 million nurses, practitioner density which is roughly about one – fourth of America and less than half that of China. The data related to hospital and beds available there is showing a skewed picture in terms of shortage of medical facilities.

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The highest priorities should be of upgrading proper health system in India in the coming decade. Luckily, some Indian hospitals are developing and renovating the existing gloomy situation which

should provide a best strategy for the remaining health care units.

("Delivering World Class Healthcare Affordably", Harvard Business Review, November 2013). The health care delivery system has improved a lot by doing break through innovations by providing the expensive health care facilities to the utmost needy patients which generally happened in internationally recognized hospitals. The medical conditions which require immediate attentions of the hospital are varying for various types of diseases like eye, heart, and maternity, orthopedics, cancer and kidney. All the hospitals, which extends the services in the above mentioned areas needs first and foremost the focus on creating or developing something new which will help ultimately the patients. The health care units should concentrates on both the category of society poor as well as wealthy patients, in terms of strategy of the hospitals. The practitioners should also practice the same philosophy in India what they would have chosen if they would be serving abroad and should be committed so that the treatment can be affordable by each class of the society. The hospital should follow the model which will consider both important aspects viz. the treatment adopted by them, should be of high quality and render at a reasonable cost. But on the contrary of this no hospital does everything for charity because they require profits for running the center as well growth purpose. The synergies can be derived if the health care units served to both the sections of society; because the affluent part force the hospitals to improve the quality standards and the deprived ones compel them to reduce the costs as much as possible. The depriving needs of Indian and other developing countries is at present served by unique health care centre, working as not for profit organization, involved in treating the eye related

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problems. The main objective of this organization is make India free from curable and preventable by year 2020 after putting efforts in days and nights together. From the statistics it is clear that approximately one fourth of world’s blind population stays in India (i.e. 12 million people out of 45 million overall blind populations). This health center actually applies the principle of 80:20 means, charging fees from one affluent patient and providing services of eye care to four patients free of cost. So far they have treated 1 million patients as a part of free surgeries. Accordingly the cost of each cataract operations has reduced to USD 30~35. This eye health care unit was established in 1984, serving the poor to poorest person of India. Three Core Areas The best health care units /hospitals concentrate on three core and important areas. First, they follow an approach of extreme prudence. It means, they employ imaginative and innovative methods to cut down the costs without sacrificing the health care quality irrespective of the size of operations of the hospital and in both medical as well non – medical fields. In case medical areas, for instance, a cardiac – care hospitals sterilizes and re – uses $ 160 steel surgical clamps, which originally sold by the manufacturer for a one – time use products. Whereas the other hospitals generally thrown – away about one third unused sutures ordered for each surgery. The order to the suture supplier should be reduced in order to save the wastage accounted here. While in the case of non – medical areas, new hospitals consider the fitting of air – conditioner in the operating rooms only at the time of designing the facility itself. All these efforts will definitely help in reducing the cost without compromising the quality. Second, the hospitals try to optimize the human resources whether professional or non – professional staff. Therefore the strategy is that doctors are not required to perform the tasks, in which the lower skill is used, better to be performed by staff itself. On the other hand, the lower

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level people can be trained for a wider range of clinical tasks. Thereby the task shifting has lead to process innovation and developing entirely new class of health workers. Thirdly, a hub and spoke network design is being used with respect to health care and associated facilities. This imparts the rational allocation of scarce resources in a much orderly manner. Much advanced technologies and highly specialized surgical skills are equipped at the hub stations and the lower level of technologies as well as the skills is being employed at spoke hospitals. The doctors at spoke treat the routine and general patients and transfer those complex cases to the hub or use some telemedicine technique to cure the patients at that place. The health care units cater services which are categorized into various departments. Every department works in synchronization with other department so that the hospitals are able to provide proper and quick treatment, which further guaranteed a fast recovery of the patient. Unimagined Innovations – Thrift itself leads of ideas and concentration of focal points mixed with principle of parsimony causes unimagined innovations. Most health care units starts producing all the inputs at their ends just to save cost and also facilitate the patients full awareness related post operative care , which the families extend to their member, especially in case of diseases like heart surgery, diabetes, cancer etc..Most of the innovations happen in the area of process in case of India, like “wheels in” and “wheels out”. By using this new concept, they are two at a time means, after operating one patient the doctor switch over to the next immediately because the other patient is already prepared while doctor was looking the previous patient. The statistics revealed that there is gap between health care facilities supplied by hospitals as against of demands. The model adopted by the successful health care units always hinges upon these vital and very important ways; the hub and spoke network system, the practice of altering the task, aggressive mindset with focused meagrely and full dedication to serve both

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poor and affluent patients. It is the need of the time that more and more reforms should introduce to the health care services in India. It is not only going to create more jobs but also provide health care, basic fundamental right to the human being at large. For checking the Quality of heart care health units JCI-the highest benchmark for quality healthcare worldwide and by NABH (National Accreditation Board for Hospitals and Healthcare Providers) in India. As the evolution of quality health care took place, JCIA was set up to counter the need of creating standards for the assessment of health care service quality. The only International set of standards applicable to all health care units world wide was introduced by JCIA firstly. The main focus in the JCIA standards was that all the hospitals should be accredited and certified by International Society for Quality in Health care (ISQUA). The patient safety is increased by manifold as all the hospital are using standard processes, proper documentation of Standard operating procedures and full proof check of all the facilities as a consequence of JCIA. It also hinges upon the improvisation of communication with the patient and keeping a tight control on the patient information as a part of facilitating respect and shielding their rights. The trust worthy medical staff is deployed for the patient services and the feedback of patients also being taken time to time to evaluate and improve the performance at all fronts. The medical staff also examines the clinical outcomes and tries to simplify it as much as possible. At present India is playing a major role in the health care domain worldwide. The main reason is that all the good health care organizations have well trained and educated doctors and supporting staff, most sophisticated technology, at a reasonably price, put forth India as one of the demanding place and viable option to consider for any medical treatment.

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The statistics shows that India has a good number of heart care hospitals, which are accredited by JCI. All sort of world class services are rendered with the use of most modern and sophisticated technology by Indian hospitals at present. This implies that the Indian Heart hospitals are recognized by JCI and the quality of treatment, care and services they deliver are understood to at par with best hospitals in US as well. The biggest advantage a patient gets here is that the cost of heart surgery incurred in Indian Hospitals is much less as compare to any other developed country like US or UK. The Indian hospitals prevailing the competitive advantage as the language used by the practitioner here in India is English, this is understood by any other country people. Indian government is also kind enough to clear the visa on medical ground without much hassle and nifty gritty involved in the matter of boarding from one country to another country. Steps to solve the problem through AHP 1. Step 1: Identifying the critical success factors The first step was to identify the critical success factors for the “process” of healthcare delivery of a tertiary care of a hospital. The critical success factors, are those key attributes of the variables which considerably affect the performance of the hospitals, has to be managed and retained for the long term success of any organization. Accordingly, three main areas were identified as the most important sections whose processes could be measured and used as indicators of the performance of healthcare delivery process in a hospital: 1. Patient care sector 2. Establishment sector 3. Administrative sector 2. Step 2: Categorize the sub- factors and their weightage

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All the critical success factors were sub-divided into sub-critical success factors again with the active involvement and discussions among the clinicians and managers in the healthcare units. The division of patient care sector was done into acute-care areas and chronic-care areas. 3. Step 3: Pair-wise comparison of critical success factors and sub-factors The predilection in AHP are basically human judgments based on human observation (this is especially true for intangibles), so vague approaches allow for a more accurate description of the decision-making process (Chen, Tzeng & Ding, 2008; Tiryaki & Ahlatcioglu, 2009) The next step was determining the importance of each critical success factor by pair-wise comparison. Multiple brainstorming sessions were held among the clinicians, doctors and support staff. The comparisons were derived for each critical success factor and then the sub-factors. The priorities were derived by comparing each set of elements in a pair-wise fashion with respect to each of the element in higher stratum. A nine-point numerical scale was used for pair wise comparison. The matrix given in table 1shows the strength with definitions of the pair-wise comparison used for prioritization. Step 4: Deriving the weights of ratings for the hospitals The next step was to derive the ratings for each sub-factor for a hospital in Barbados and Indian hospitals. The clinicians of various hospitals as well as the managers were interviewed regarding the ratings of each sub-factor. Ratings of each sub-factor were allocated to each unit in the given hospital according to the clinician or managers’ view of where the particular unit stands according to the attribute. Hierarchy Development The hierarchy of the problem is build up, shown here in the form of graph of the problem in terms of the overall goal, the criteria, and the decision alternatives.

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The diagram below (figure -1) shows the AHP hierarchy at the end of the decision making process. The main objective here is to select the best and most appropriate hospital based on four specific criteria. MAX HOSPITAL is the preferred alternative, with an overall priority of 0.493. It is preferred about a third more strongly than FORTIS HOSPITAL, whose priority is 0.358, and about three times more strongly than APOLLO HOSPITAL, whose priority is only 0.149. Cost is the most important criterion with respect to reaching the goal, followed by Infrastructure, Surgeon’s experience, and quality. These factors are weighted 0.547, 0.270, 0.127, and 0.056, respectively. The balance of this article describes the derivation of these priorities. Figure -1 Goal Hierarchy of AHP

Overall Goal Criteria Decision Alternatives

Select the Best Surgery Surgeon’ sExperie   nce

Infrastruct   ure

Fortis

Fortis

Fortis

Fortis

Max

Max

Max

Max

Apollo

Apollo

Apollo

Apollo

Cost  

Quality  

As the decision makers continue with the AHP, they will determine priorities for the hospitals with respect to each of the decision criterion (cost, surgeon’s experience, infrastructure and quality), and weightages for each of the criteria with respect to their importance. The priorities will then be combined throughout the hierarchy to give an overall priority for each hospital. The hospital with the highest priority will be the most suitable alternative for the utilizing the health

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care facilities in India. The ratios of the other hospitals priorities will indicate their relative strengths in reaching the Goal.

Pairwise Comparison Pair wise comparisons forms the fundamental building blocks of Analytic Hierarchy Process (AHP). In establishing the priorities for the four criterions, Analytic Hierarchy Process will state how important each criterion is relative to each other criterion when the criteria are compared two at a time (pair wise) The criterions chosen were cost, surgeon’s experience, infrastructure and quality, and the information related to each is being mentioned here: 1. cost In case of any treatment carried out, cost is the most factor in determining best hospital where the treatment or surgery to be performed, create satisfactory results. The total cost incurred in any treatment depends upon many items such as: . Type of equipments employed (special or general); . Dedicated operation theatres; . Specialist doctor. 2. Surgeon’s experience Surgeon’s experience also plays a vital role in deciding the best healthcare unit. The major surgery requires experienced surgeons which otherwise would result in a more complications or even death in some cases. In minor surgeries, the less experienced surgeon can perform the task of operations.

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The patients should cross – check the testimonials of any doctor who is appointed there in the hospital. Above to it that doctor must be familiar with the kind of problem any patient is suffering and line of action (or treatment required in that critical situation) to be properly done in consultation with other doctors as well as the family members. Another very important point with regards to the surgeon’s experience, which is looked upon by the patient is that how many surgeries already conducted by that doctor in the past so far. 3. Infrastructure The clinicians and doctors cannot start any additional surgery without the proper support of infrastructure or the facility conditions available in the hospital. The important question generally raised here is that whether the present infrastructure will support the essential items in case of any emergency. Therefore the present infrastructure should support new or any emergency surgery, which includes following things: -

Surgical equipments

-

No. of beds for patients

-

Intensive care facility (ICU’s, ventilator, blood bank facility etc.)

-

Availability of all medicines in the same campus.

4. Quality It requires additional care in terms of immediate look after of the patients as and when it needed, Patient safety, overall satisfaction of the patient and their family members. Hospitals with a good organisation of care (such as improved nurse staffing and work environments, hygiene availability of everything without any delay) can affect the patient care.

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The success of heart surgery is depending upon many factors as it require modern and sophisticated technology and all the doctors, nurses must be well informed and knowledgeable to work with it. Many times the patient is required to keep in Intensive care units (ICUs) after the operation, as well as the hygienic condition of that ICU’s also plays a vital and important role in the selection of a hospital as such. Sometimes, the treatment needs the blood to transfuse to the patient in case of exigency so all these facilities to be equipped in the hospital. JCI which is the highest standard of quality world wide, recognized all the good heart hospital after the proper evaluation of the performance as well as the checking of the laid out criteria by JCI. These criteria involve a whole list of items comprising of the quality infrastructure, equipment, hygienic condition, availability if ICU’s and blood bank etc. Comparison Scale - The comparison between two elements using AHP can be done in different ways. However, the relative importance scale between two alternatives suggested by Saaty (SAATY, 2005) is extensively used in the decision making exercises. The values of various attributes vary from 1 to 9, as per the relative importance of the alternatives provided to the different criterion involved in case as such. (Table -1) Table 1 – Basis for Pair wise Comparison Scale Scale

Numerical Rating

Extremely Preferred

9

Very Strong to Extremely

8

Very Strongly Preferred

7

Strongly to Very Strongly

6

Strongly Preferred

5

14   

Moderately to Strongly

4

Moderately Preferred

3

Equally to Moderately

2

Equally Preferred

1

Comparison Matrix (for the criterion involved in the decision making problem) Once the goal hierarchy was recognized, all the criteria must be estimated in pairs, which decide the relative significance between any two criteria, further to their relative priority to the ultimate (final) goal. The decision making exercise starts by finding out the relative weight of the initial criteria group. Table 2 shows the relative weight data between the criterions. Table 2 – Pair Wise Comparison of the Decision Criterion cost

Surgeon’s

infrastructure

quality

experience 1

4

3

7

¼ = 0.25

1

1/3=0.33

3

infrastructure

1/3=0.33

3

1

5

quality

1/7=0.14

1/3= 0.33

1/5 = 0.2

1

cost Surgeon’s experience

In order to interpret and the relative weights are assigned to every criterion, by the process of normalization. The method of normalization is simply by doing the sum of each column values and then each cell value is to be divided by the total value of the respective column. Next step is to compute the average of each row elements of the normalized pair wise comparison matrix. These averages confer the priorities for the criteria chosen for the problem of best hospital in India (Table 3).

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Table 3 – Priorities of the Decision Criterion (After Normalization) cost

Surgeon’s

infrastructure

quality

Priority

experience Cost

0.58

0.4819

0.666

0.4375

0.547

Surgeon’s

0.147

0.120

0.0733

0.1875

0.127

infrastructure

0.194

0.361

0.222

0.3125

0.270

quality

0.08

0.039

0.044

0.0625

0.056

experience

Consistency – After getting the results of the priorities of the various criterion specified in the AHP problem, the very important part is to check whether the pair wise comparison considered is to reliable or acceptable enough to further take along for the purpose of determining the overall priority of three health care units itself. As establish by Satty, the procedure says to find out the consistency ratio (CR), preceded by the consistency Index (CI). With numerous pair wise comparisons, perfect consistency is difficult to achieve. In fact, some degree of inconsistency can be expected to exist in almost any set of pairwise comparisons. To handle the consistency issue, Analytic Hierarchy Process provides a method for measuring the degree of consistency among the pairwise comparisons provided by the decision maker. If the degree of consistency is unacceptable, the decision maker should review and revise the pair wise comparisons before proceeding. The steps involved in computing the Consistency Index (CI) first and thereafter the Consistency Ratio (CR) is elaborated here in detail. Step 1: Find out the λmax with respect to each criterion (cost, surgeon’s experience, infrastructure and quality) 16   

1

4

3

7

0.547

0.547

0.25 1

0.33

3

0.127

0.33 3

1

5

0.270

0.270

0.14 0.33

0.20

1

0.056

0.056

===

2.257 0.521

λmax

0.127

0.547 ===

λmax

0.127

1.112

0.270

0.228

0.056

Step – 2: (Cost) max = 2.2257/0.547 = 4.126 (Surgeon’s experience) max = 4.1011 (Infrastructure) max = 4.1167 (Quality) max = 4.08017 Step – 3: Computing the average of the values found in Step-2, this average is denoted by λmax. λmax = (4.126+4.1011+4.1167+4.08017) / 4 = 4.1059 Step – 4: Computing consistency Index (CI) CI == (λmax --- N) ----------------(N – 1) Where N = no. Of items being compared CI = (4.1059-4) / (4-1) = 0.0353 Step – 5: Computing consistency ratio (CR) CR = CI / RI 17   

Where RI = Random Index which is based on the number of criteria considered in a specific problem for evaluation purpose, as shown in table 4.

Table 4 – Random Index values (RI) n

1

2

3

4

5

6

7

8

9

10

RI

0

0

0.58

0.9

1.12

1.24

1.32

1.41

1.45

1.49

Thus, for N = 4, RI = 0.90 from the above table, therefore CR (Consistency ratio) CR = 0.0353 / 0.90 = 0.039< 0.1 Since, the consistency ratio is coming 0.039 which is less than 0.1. As per the procedure of Analytical hierarchy process if the consistency ratio is achieved less than or equal to 0.1, we can conclude that the pair wise comparison taken here is appropriate and acceptable to move further in the direction of finding out the overall priority in terms of selecting the best possible healthcare unit in the present scenario. After this the next step is taking all the tree alternative of hospital should be picking up for the pair wise comparison purpose with respect to the four criteria chosen for the case. These pair wise comparison has arrived based on the opinion of the people who have already availed or know about the services of the tree healthcare units mentioned herein (Table 5, 6, 7 and 8). Table 5 – Pair Wise comparison of three Healthcare units for Cost criteria Healthcare unit

Fortis

max

apollo

fortis

1

¼

4

18   

Max

4

1

9

apollo

1/4

1/9

1

Table 6 – Pair Wise comparison of three Healthcare units for Surgeon’s experience criteria Healthcare unit

fortis

max

apollo

fortis

1

3

1/5

max

1/3

1

1/7

apollo

5

7

1

Table 7 – Pair Wise comparison of three Healthcare units for Infrastructure criteria Healthcare unit

fortis

max

apollo

fortis

1

5

9

max

1/5

1

4

apollo

1/9

1/4

1

Table 8 – Pair Wise comparison of three Healthcare units for Quality criteria Healthcare unit

fortis

max

apollo

fortis

1

1/3

5

max

3

1

9

apollo

1/5

1/9

1

The next step in AHP is finding out the priority of the three units in terms of the predefined four criteria in the same manner as prescribed earlier i.e. first do the normalization of the matrix and 19   

then take the average of the row elements to highlight the priority of the specific criteria (Normalized Table of four criterions – 9, 10, 11 and 12). Table 9 -Establishing priorities for 3 healthcare units with respect to Cost Criteria by Normalization hospital

fortis

max

fortis

1/5.25 =

0.25 / 1.36 = 4/14=0.285

0.190

0.183

4/5.25=0.761

1 / 1.36 =

max

apollo

9/14=0.642

Priority 0.217

0.717

0.7352 apollo

6/11 =

0.111/1.36=0.081 1 / 14=0.071

0.066

0.55

Table 10 -Establishing priorities for 3 healthcare units with respect to Surgeon’s experience Criteria by Normalization hospital

Fortis

max

apollo

fortis

1 / 6.33=0.157

3/11 =

0.2 / 1.342 = 0.188

0.272

0.149

0.33 / 6.33 =

1 / 11 =

0.142/ 1.342 =

0.052

0.090

0.105

5 / 6.33=

7 / 11 =

1 / 1.342 =

0.789

0.636

0.745

max

apollo

Priority

0.081

0.731

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Table 11 -Establishing priorities for 3 healthcare units with respect to Infrastructure Criteria by Normalization hospital

fortis

max

apollo

Priority

fortis

0.763

0.8

0.642

0.743

max

0.152

0.16

0.285

0.194

apollo

0.083

0.04

0.071

0.063

Table 12 -Establishing priorities for 3 healthcare units with respect to Quality Criteria by Normalization hospital

fortis

max

apollo

Priority

fortis

0.238

0.229

0.33

0.265

0.694

0.6

0.672

0.076

0.066

0.063

max 0.714 apollo

0.047

Thus, the priorities achieved for each healthcare unit as against four criterions can be summarized as mentioned in the table 13. Table 13 – Final Priorities of the Three Healthcare units in terms of the criterion Healthcare

Cost

Unit

Surgeon’s

Infrastructure

Quality

experience

fortis

0.217

0.188

0.743

0.265

max

0.717

0.081

0.194

0.672

apollo

0.066

0.731

0.063

0.063

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The last step of Analytical Hierarchy process is to find out the overall priority of three healthcare units considered here in this case. Overall Priority of all three Healthcare Units Overall Priority for Fortis = 0.547x0.217+0.127x0.188+0.27x0.743+0.056x0.265 = 0.358 Overall Priority for Max = 0.547x.717+0.127x0.081+0.270x0.194+0.056x.672 = 0.4925 Overall Priority for Apollo = 0.547x0.066+0.127x0.731+0.270x0.063+0.056x0.063 = 0.1495 The necessary computation although shown here is done manually but if the number of criterion involved are too many and the evaluators are not the single person but the group of people are require then in that case Expert Choice Software is being used to do all computation work. Conclusion The results of the above case studies highlight that the application of AHP in selection of best health care units is unenviable to get the better outcome of the team decision making process. The model proposed here in this paper can be used as a framework by the patients looking for the best hospital to treat the problem related to heart as such. If by the passage of time few more critical success factors the evaluator wants to establish in the present prescribed model can be easily accommodated as the AHP process is a multi criteria problem solving technique. Also, the health care unit selection could be made in a more routine task by putting all the inputs in the standard software available like Expert Choice, just to make it more cumbersome and routine. In case of few more criteria and sub criteria to be added, the data collection and computational

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problems would increase, along with if we increase the number of alternatives in the selection portfolio. This is one of the reasons that we suggested short listing the health care units and then applying the AHP model. Also, as it is shown here, the number of success factors can be grouped to minimize the number of criteria and sub criteria used in formulating the AHP model. The final judgment in the present case with regards to the best health care unit is Max Hospital with a highest priority of 0492, which satisfying all the criteria taken here in terms of defining the bets hospital. The computation clearly indicates that the second choice goes to Fortis, followed by the Apollo as the overall priority score results here in the present situations. All those hospitals have the expertise, experience and resources capable of achieving the very highest levels of healthcare satisfaction round the clock which are defining and set criteria by JCI.

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