Prioritizing enablers for service quality in healthcare sector - a DEMATEL approach.

PURPOSE: The Healthcare sector is one of the important sectors of the Service Industry. It is believed that in this sector, the customer server relationship is very critical, and even the slightest gap in the people quality may have a huge impact on the delivered service quality. Some of these enablers are doctors, nursing staff and support staff. Furthermore, the nonpeople quality enablers such as diagnostic services, facilities, hygiene levels and so on are also likely to impact the delivered service quality. It was also felt that the degree of impact each enabler has on the service quality could vary. Therefore there is a need for structured and deep analysis. The paper attempts to identify, analyze and prioritize the enablers that impact the delivered service quality. DESIGN/METHODOLOGY/APPROACH: The enablers have been identified through literature review and inputs from experts in the healthcare fraternity. The authors have explored different decision-making tools such as analytic hierarchy process (AHP), analytic network process (ANP), stepwise weight assessment ratio analysis, Hybrid Model and DEMATEL (Decision-Making Trial and Evaluation Laboratory) for the analysis of data in this paper. Based on the strengths of the approach and careful considerations by focus group discussions, DEMATEL was chosen as the best option. It is simple, unique, sparingly used in the healthcare sector, effective in prioritizing and gives meaningful insights on importance, cause and effect factors. DEMATEL approach converts the complex problem with interrelated factors into a clear structure that makes simple interrelationships among factors in the form of cause and effects digraph, and hence, the authors chose to use it. A case study in one of the hospitals has also been conducted to demonstrate the applicability of the developed index. The case study very strongly validates the developed index. FINDINGS: This research paper has found that there are people quality enablers such as the doctor, nursing staff, support staff and nonpeople quality enablers such as facilities, diagnostic services and hygiene levels maintenance, which impact the delivered service quality. It also concludes that the delivered service quality depends not only on the quality but also on the availability of these enablers. The inputs received from the experts have been run through the DEMATEL methodology and importance computed for each. The top five priority enablers are Quality of Doctor, Availability of Doctor, Quality of Support Staff, Quality of Nursing Staff and Availability of Support Staff. RESEARCH LIMITATIONS/IMPLICATIONS: The weights of the enablers have been obtained using the DEMATEL tool. These weights have been calculated using the inputs from 22 experts, which meets the statistical requirement (Skulmoski, 2007). However, a larger group of experts can be reached, and based on the inputs received from them, the tool can be revalidated for repeatability and reproducibility. Using Fuzzy DEMATEL can also be explored for further analysis. PRACTICAL IMPLICATIONS: The proposed framework to assess the service quality level of a healthcare organization is based on a sound approach of DEMATEL. The service index arrived, thereafter, can be used to rate the delivered service quality by any healthcare organization. It can be used to compare the similar type of healthcare organizations across locations. This Index can facilitate improvements in the healthcare organization through internal and external benchmarking. It also helps the organization to know the gaps, understand the root cause, improve upon them and become the best in class. This Index uses the inputs from the end customers to calculate the rating, which makes it more reliable and accurate. The overall scores obtained from the Index can provide the ranking to the healthcare providing organizations and options to customers to choose from best. The service quality index can be used by an organization to continuously monitor their delivered service quality scores and improve them to become the best in class. The research paper highlights the significant role played by the people quality and its strong impact/contribution on the delivered service quality. Hence, it is believed that it will encourage the healthcare organizations to prioritize the improvement and upgrade of the people quality over the nonpeople quality aspect. ORIGINALITY/VALUE: Putting people and nonpeople quality enablers in one single model and assigning weights to them using the DEMATEL approach is a new application in healthcare. Developing an Index to measure the delivered service quality in the healthcare sector is also different and new.

Application of a system dynamics approach for assessment and mitigation of CO2 emissions from the cement industry.

A system dynamics model based on the dynamic interactions among a number of system components is developed to estimate CO(2) emissions from the cement industry in India. The CO(2) emissions are projected to reach 396.89 million tonnes by the year 2020 if the existing cement making technological options are followed. Policy options of population growth stabilisation, energy conservation and structural management in cement manufacturing processes are incorporated for developing the CO(2) mitigation scenarios. A 42% reduction in the CO(2) emissions can be achieved in the year 2020 based on an integrated mitigation scenario. Indirect CO(2) emissions from the transport of raw materials to the cement plants and finished product to market are also estimated.

Investigations of methane emissions from rice cultivation in Indian context.

The increasing demand of the growing population requires enhancement in the production of rice. This has a direct bearing on the global environment since the rice cultivation is one of the major contributors to the methane emissions. As the rice cultivation is intensified with the current practices and technologies, the methane fluxes from paddy fields will substantially rise. Improved high yielding rice varieties together with efficient cultivation techniques will certainly contribute to the curtailment of the methane emission fluxes. In this paper, the system dynamic approach is used for estimating the methane emissions from rice fields in India till the year 2020. Mitigation options studied for curtailing the methane emissions include rice production management, use of low methane emitting varieties of rice, water management and fertilizer amendment. The model is validated quantitatively and sensitivity tests are carried out to examine the robustness of the model.