A multicriteria decision making approach applied to improving maintenance policies in healthcare organizations.
A multicriteria decision making approach applied to improving maintenance policies in healthcare organizations.
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DOI：
10.1186/s12911-016-0282-7
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发表时间：
2016-04-23
影响因子：
3.5
通讯作者：
Gómez A
中科院分区：
文献类型：
--
作者：
Carnero MC;Gómez A
医疗保健组织对其医疗设备的维护需求比其他组织大得多，因为许多设备是直接与患者一起使用的。然而，关于医疗机构资产管理的文献非常有限。本研究的目的是提供更合理的维修政策的应用，从而提高护理质量。本文描述了一种多标准决策方法，该方法将马尔可夫链与基于分类评估技术（MACBETH）的多标准吸引力测量相结合，通过使用多学科决策组的判断来促进维护策略组合的最佳选择。拟议的办法考虑到专业人员对某一备选办法的接受程度。它还考虑到与费用、护理质量和护理覆盖的影响有关的标准。这种多标准方法适用于四个透析子系统：丙型肝炎患者、乙型肝炎患者、急性和慢性肝炎患者；在所有情况下，获得的维护策略包括应用纠正性和预防性维护以及两个备用机器。本研究在决策实践中的附加价值来自：(i)整合马尔可夫链的使用，以获得由多标准方法评估的替代方案；（二）建议使用麦克白对医疗机构的资产管理作出合理决策；（iii）应用多标准方法在卫生保健组织的四个透析子系统中选择一套或组合维护政策。在提出的多标准决策方法中，使用了与患者所需的护理质量（可用性）相关的经济标准，以及考虑到组织中存在的维护和医疗保健资源的每个备选方案的接受程度，并包括决策小组。这种方法更适合实际的医疗保健组织实践，并且根据所分析的子系统，引入了正常维护策略中不包括的改进；通过这种方式，不仅可以提出不同的维护策略，还可以根据可行性，在每种情况下为维护经理提供更完整的决策工具。
Healthcare organizations have far greater maintenance needs for their medical equipment than other organization, as many are used directly with patients. However, the literature on asset management in healthcare organizations is very limited. The aim of this research is to provide more rational application of maintenance policies, leading to an increase in quality of care. This article describes a multicriteria decision-making approach which integrates Markov chains with the multicriteria Measuring Attractiveness by a Categorical Based Evaluation Technique (MACBETH), to facilitate the best choice of combination of maintenance policies by using the judgements of a multi-disciplinary decision group. The proposed approach takes into account the level of acceptance that a given alternative would have among professionals. It also takes into account criteria related to cost, quality of care and impact of care cover. This multicriteria approach is applied to four dialysis subsystems: patients infected with hepatitis C, infected with hepatitis B, acute and chronic; in all cases, the maintenance strategy obtained consists of applying corrective and preventive maintenance plus two reserve machines. The added value in decision-making practices from this research comes from: (i) integrating the use of Markov chains to obtain the alternatives to be assessed by a multicriteria methodology; (ii) proposing the use of MACBETH to make rational decisions on asset management in healthcare organizations; (iii) applying the multicriteria approach to select a set or combination of maintenance policies in four dialysis subsystems of a health care organization. In the multicriteria decision making approach proposed, economic criteria have been used, related to the quality of care which is desired for patients (availability), and the acceptance that each alternative would have considering the maintenance and healthcare resources which exist in the organization, with the inclusion of a decision-making group. This approach is better suited to actual health care organization practice and depending on the subsystem analysed, improvements are introduced that are not included in normal maintenance policies; in this way, not only have different maintenance policies been suggested, but also alternatives that, in each case and according to viability, provide a more complete decision tool for the maintenance manager.