The Eleventh International Symposium on the Analytic Hierarchy Process Paolo Melillo 1, Alice Delle Donne 1, Giovanni Improta 1, Santolo Cozzolino 2, Marcello

The Eleventh International Symposium on the Analytic Hierarchy Process

Paolo Melillo1, Alice Delle Donne1, Giovanni Improta1, Santolo Cozzolino2, Marcello Bracale1

1Department of Biomedical, Telecommunication and Electronic EngineeringUniversity of Naples “Federico II”

2Centro di Biotecnologie - A.O.R.N. "A. Cardarelli" [email protected]

June 15-18, 2011, SORRENTO, Naples, ITALY

mailto:[email protected]

ISAHP 2011

Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale

Case study: patients who used the service of pharmaceutical distribution of the hospital “A.O.R.N. A. Cardarelli” in Naples (about 1000 users for year).

Increasing interest for the patient satisfaction among research activity:

Number of papers indexed in PubMed with the word “satisfaction” in the title(over the years 1995-20005) Total number: 6728 articles, almost half of which have been published since 2000

Speight J. Assessing Patient Satisfaction: Concepts, Applications, and Measurement. Value in Health. 2005;8:S6-S8.

ISAHP 2011


Patient satisfaction can be described as: “the extent of an individual's experience compared with his or her expectations” (Asadi-Lari, 2004);

Shikiar and Rentz have proposed a three-level hierarchy of satisfaction:1)satisfaction with health-care delivery (i.e., the clinic or service, including issues of accessibility, clinician-patient communication, quality of facilities);2)satisfaction with treatment 3)satisfaction with medicationIn our case study, we are interested in the first level

“There is no gold standard when it comes to measuring patient satisfaction” (Speight)

Asadi-Lari M, Tamburini M, Gray D. Patients' needs, satisfaction, and health related quality of life: towards a comprehensive model. Health Qual Life Outcomes. 2004 Jun 29;2:32.Shikiar R, Rentz AM. Satisfaction with medication: an overview of conceptual, methodologic, and regulatory issues. Value Health. 2004 Mar-Apr;7(2):204-15.Speight J. Assessing Patient Satisfaction: Concepts, Applications, and Measurement. Value in Health. 2005;8:S6-S8.

ISAHP 2011


From a recent review by Panvelkar we knew that:

the studies measured patient satisfaction with pharmacy service adopted questionnaires administered in different ways (face to face interviews or via telephone or mailed …);

only few studies compared patient satisfaction with services provided at different types of pharmacies;

the majority of studies measured satisfaction using self-developed, non validated instruments or ad hoc instruments with items adapted from previously published papers.

Panvelkar PN, Saini B, Armour C. Measurement of patient satisfaction with community pharmacy services: a review. Pharm World Sci. 2009 Oct;31(5):525-37.

Of theISAHP 2011


Item Dimension

1. Pharmacy location

d1. Facilities2. Accessibility

3. Room comfort

4.Courtesy

d2. Personnel’s skills5.Pharmacists’ explanation

6. Privacy

7. Drugs’ availabilityd3. Dispensing process8. Waiting time

9. Opening time

Panvelkar, P.N., Saini, B., & Armour, C. (2009). Measurement of patient satisfaction with

community pharmacy services: a review. Pharmacy World & Science, 31, 525-537.

ISAHP 2011


The questionnaire submitted to the patients consisted of three parts:

1)questions about sex, age and other anonymous information;

2)questions about the level of satisfaction of each item (LSi) and dimension (LSdi);

3)questions for the pair-wise comparisons of items and dimensions according to AHP methods.

ISAHP 2011


The pharmacy is easy to reach5- strongly agree 4- agree 3- not sure 2 – disagree 1- strongly disagree LS1

The pharmacy staff is always kind 5- strongly agree 4- agree 3- not sure 2 – disagree 1- strongly disagree LS4

The prescribed drugs are always available in stock5- strongly agree 4- agree 3- not sure 2 – disagree 1- strongly disagree LS7

The building is also accessible to disabled people5- strongly agree 4- agree 3- not sure 2 – disagree 1- strongly disagree LS2

The pharmacist is available for giving information5- strongly agree 4- agree 3- not sure 2 – disagree 1- strongly disagree LS5

The time needed to serve is short or reasonable5- strongly agree 4- agree 3- not sure 2 – disagree 1- strongly disagree LS8

The waiting room is adequate and comfortable5- strongly agree 4- agree 3- not sure 2 – disagree 1- strongly disagree LS3

The pharmacist take care about my privacy5- strongly agree 4- agree 3- not sure 2 – disagree 1- strongly disagree LS6

The opening hours of the pharmacy are adequate5- strongly agree 4- agree 3- not sure 2 – disagree 1- strongly disagree LS9

The facilities (in terms of location, accessibility, comfort of the rooms) are adequate5- strongly agree 4- agree 3- not sure 2 – disagree 1- strongly disagree LSd1

The attitude of pharmacist towards patients (courtesy, availability, respect of privacy) is satisfactory5- strongly agree 4- agree 3- not sure 2 - disagre 1- strongly disagree LSd2

The service (availability of drugs, waiting times, opening hours) is satisfactory 5- strongly agree 4- agree 3- not sure 2 - disagre 1- strongly disagree LSd3

Express your global level of satisfaction of the service in a scale 1-100 GLS

The levels of satisfaction of each item (LSi) and of each dimension (LSdi) were evaluated by the 5-point Likert scale,

A Global Level of Satisfaction (GLS) is asked to the users in a scale from 1 to 100

ISAHP 2011


For each respondent, we computed according to AHP:1)the local weight (LWi) of each item within its dimension2)the weight of each dimension (Wdi);3)the global weight (GWi) of each item.

Description Formula GQI Global quality index

9

1iii GWLS

QId1 Quality index of the dimension Facilities

3

1iii LWLS

QId2 Quality index of the dimension Personnel’s skills

6

4iii LWLS

QId3 Quality index of the dimension Dispensing process

9

7iii LWLS

We defined:a Global Quality Index (GQI) as a linear combination of the level of satisfaction of each item, LSi, and their global weight, Gwi;a Quality Index (QIdi) as a linear combination of the level of satisfaction of the items of the dimension, LSi,,and their local weight, GWi.

We evaluated the correlation between GLS and GQI of the respondents and between LSdi and QIdi.

ISAHP 2011


We computed the consistency measures of the judgment matrix (Saaty, 1980);

We accepted as consistent matrixes within the 20% level of inconsistency (Pecchia, 2010).

As regards the respondents, we accepted an inconsistency in one judgment matrix.

Saaty, T.L. (1980). The Analytic Hierarchy Process: Planning, Priority Setting, Resource Allocation. New York: McGraw-Hill.

Pecchia, L., Bath, P.A., Pendleton, N. & Bracale, M.(2010). Web-based System for Assessing Risk Factors for Falls in Elderly People. International Journal of the Analytic Hierarchy Process, 2, 135-157

ISAHP 2011


We computed the consistency measures of the judgment matrix (Saaty, 1980);

We accepted as consistent matrixes within the 20% level of inconsistency (Pecchia, 2010).

As regards the respondents, we accepted an inconsistency in one judgment matrix.

Saaty, T.L. (1980). The Analytic Hierarchy Process: Planning, Priority Setting, Resource Allocation. New York: McGraw-Hill.

Pecchia, L., Bath, P.A., Pendleton, N. & Bracale, M.(2010). Web-based System for Assessing Risk Factors for Falls in Elderly People. International Journal of the Analytic Hierarchy Process, 2, 135-157

ISAHP 2011


A sample of 101 users of the service completed the questionnaire.

74 subjects refused to answer the questionnaire for unknown reasons.

Patients interviewed(n=49)

Users (non patient) interviewed (n=52)

Age (year) 49.0 ± 14.7 48.7 ±12.1

Male 31 (63.3%) 28 (53.8%)

Female 18 (36.7) 24 (46.2%)

ISAHP 2011


AHP-based index Level of Satisfaction # Correlation coefficient

p-value

GQI: Global Quality Index GLS: Global Level of Satisfaction 22 0.5164 0.014

QId1: Quality Index referred

to Facilities

LSd1: Level of Satisfaction

referred to Facilities

29 0.8285 <0.001


to Personnel’s skills


referred to Personnel’s skills

42 0.5650 <0.001


to Dispensing process


referred to Dispensing process

32 0.3649 0.040

The correlations were significant for all indexes (p-value <0.05)

ISAHP 2011


In order to check the application of the AHP methods:we defined AHP-base quality indexes;

we evaluated the correlation of these indexes with the Level of Satisfaction asked to the respondents for redundancy;

The significant correlation show that the AHP method could be used to provide information about the quality of the service, the patient satisfaction and the importance of each item / dimension.

Limitation of the current study:•most of the respondents were inconsistent in their judgment; •we did not adopt a conventional methods for measuring quality as benchmark;•we did not pool the judgments (out of the aim of the study).

ISAHP 2011


Our results are consistent with those proposed by Ramanathan, who compared the use of AHP and SERVQUAL to measure quality service quality of a company engaged in pharmaceutical distribution.

Ramanathan concluded that customers could express their satisfaction and comparisons more easily with the AHP questionnaire than with SERVQUAL.

Ramanathan stated that same respondent has been diagnosed to be an unhappy customer by SERVQUAL and happy by AHP.

The method proposed is based on a fewer number of questions than Ramanathan

Ramanathan, R., & Karpuzcu H. (2010). Comparing perceived and expected service using an AHP model: an application to measure service quality of a company engaged in pharmaceutical distribution. OPSEARCH

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The Eleventh International Symposium on the Analytic Hierarchy Process Paolo Melillo 1, Alice Delle Donne 1, Giovanni Improta 1, Santolo Cozzolino 2, Marcello