An integrated multi-criteria decision-making approach for evaluating healthcare service quality: a provider-centric assessment

The aim of this study is to present, from the service providers' perspective, a multi-level integrative approach toward prioritization of the factors that are important for healthcare service quality (HSQ). This is necessary to assign and apportion resources and attention to specific areas of concern and help in their improvement, leading to satisfying the overall objective of improving healthcare delivery in the Indian context. We employed an integrated decision-making trial and evaluation laboratory (DEMATEL), interpretive structural modelling (ISM), and Matrice d'Impacts Croisés Multiplication Appliquée á un Classement (MICMAC) approach to identify the key factors influencing HSQ. We classify these variables into different groups based on their influence and dependence power. Sensitivity analysis is used to verify the consistency of the responses across scenarios and the robustness of the results. The study's findings indicate that the key factors influencing HSQ are (1) quality of medical staff (experience, education), (2) government support (funding, insurance, etc.), and (3) availability of doctors and support staff. These factors are both cause and driver factors. Sensitivity analysis indicates that the outcomes are reliable and consistent across different sample sizes. Previous studies predominantly used SERVQUAL to assess HSQ from the customer's view or end-user's viewpoint, with little focus on multi-criteria decision making (MCDM). This study uniquely evaluates HSQ from the service provider's perspective using integrated MCDM methods. It also demonstrates the utility of integrated decision-making tools for tackling complex, interdependent challenges in healthcare quality enhancement.