Analysis of the operational risk factors in public hospitals in an Indian state: A hybrid DEMATEL–ISM–PROMETHEE approach
International Journal of Health Care Quality Assurance
ISSN: 0952-6862
Article publication date: 30 December 2019
Issue publication date: 15 January 2020
Abstract
Purpose
Risk management in the healthcare sector is a highly relevant sub-domain and a crucial research area from the humanitarian perspective. The purpose of this paper is to focus on the managerial/supply chain risk factors experienced by the government hospitals in an Indian state. The present paper analyzes the inter-relationships among the significant risk factors and ranks those risk factors based on their criticality.
Design/methodology/approach
The current research focuses on 125 public hospitals in an Indian state. Questionnaire-based survey and personal interviews were conducted in the healthcare sector among the inpatients and hospital staff to identify the significant risk factors. An integrated DEMATEL–ISM–PROMETHEE method is adopted to analyze the impact potential and dependence behavior of the risk factors.
Findings
The analysis asserts the absence of critical risk factors that have a direct impact on patient safety in the present healthcare system under investigation. However, the results illustrate the remarkable impact potential attributed to the risk factor, namely, staff shortage in inducing other risk factors such as employee attitudinal issues, employee health issues and absenteeism altogether resulting in community mistrust/misbeliefs. Maintenance mismanagement, monsoon time epidemics, physical infrastructure limitations are also found to be significant risk factors that compromise patient satisfaction levels.
Practical implications
Multiple options are illustrated to mitigate significant risk factors and operational constraints experienced by public hospitals in the state. The study warrants urgent attention from government officials to fill staff vacancies and to improve the infrastructural facilities to match with the increasing demand from the society. Furthermore, this research recommends the hospital authorities to start conducting induction and training programs for the hospital employees to instill the fundamental code of conduct while working in hectic, challenging and even in conditions with limited resources.
Originality/value
Only limited papers are visible that address the identification and mitigation of risk factors associated with hospitals. The present paper proposes a novel DEMATEL–ISM–PROMETHEE integrated approach to map the inter-relationships among the significant risk factors and to rank those risk factors based on their criticality. Furthermore, the present study discloses the unique setting of the public healthcare system in a developing nation.
Keywords
Acknowledgements
The authors express their sincere gratitude to the civilians and healthcare professionals for their participation in data collection. The authors would also like to thank the reviewers and the editors for their constructive comments. They also acknowledge Anil Kumar E.N., Research Scholar, NITC and the ex-undergraduate students of NITC Allu Bharadwaj, Avinash S. Mallya, Ayush Naithani, Jijo Johnson, Nishal Thampan and Sarath Kumar C.B. for assisting in conducting the survey. Finally, the first author is grateful to the Ministry of Human Resource Development, Government of India for granting the PhD research fellowship.
Citation
Vishnu, C.R., Sridharan, R., Ram Kumar, P.N. and Regi Kumar, V. (2020), "Analysis of the operational risk factors in public hospitals in an Indian state: A hybrid DEMATEL–ISM–PROMETHEE approach", International Journal of Health Care Quality Assurance, Vol. 33 No. 1, pp. 67-88. https://doi.org/10.1108/IJHCQA-06-2018-0156
Publisher
:Emerald Publishing Limited
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