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 Engineering
University of Naples “Federico II”
2Centro di Biotecnologie - A.O.R.N. "A. Cardarelli" Naples
[email protected]
June 15-18, 2011, SORRENTO, Naples, ITALY
ISAHP 2011
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.
Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale
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 medication
In 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.
Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale
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.
Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale
Of the
ISAHP 2011
Item
Dimension
1. Pharmacy location
2. Accessibility
d1. Facilities
3. Room comfort
4.Courtesy
5.Pharmacists’ explanation
d2. Personnel’s skills
6. Privacy
7. Drugs’ availability
8. Waiting time
d3. Dispensing
process
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
Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale
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.
Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale
ISAHP 2011
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
The pharmacy is easy to reach
5- 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 stock
5- strongly agree
4- agree
3- not sure
2 – disagree 1- strongly disagree
LS7
The building is also accessible to disabled people
5- strongly agree
4- agree
3- not sure
2 – disagree 1- strongly disagree
LS2
The pharmacist is available for giving information
5- strongly agree
4- agree
3- not sure
2 – disagree 1- strongly disagree
LS5
The time needed to serve is short or reasonable
5- strongly agree
4- agree
3- not sure
2 – disagree 1- strongly disagree
LS8
The waiting room is adequate and comfortable
5- strongly agree
4- agree
3- not sure
2 – disagree 1- strongly disagree
LS3
The pharmacist take care about my privacy
5- strongly agree
4- agree
3- not sure
2 – disagree 1- strongly disagree
LS6
The opening hours of the pharmacy are adequate
5- 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 adequate
5- 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 satisfactory
5- 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
Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale
ISAHP 2011
For each respondent, we computed according to AHP:
1) the local weight (LWi) of each item within its dimension
2) the weight of each dimension (Wdi);
3) the global weight (GWi) of each item.
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.
GQI
Description
Global quality index
Formula
9
 LS  GW
i 1
QId1 Quality index of the dimension
Facilities
i
i
3
 LS  LW
i 1
i
i
QId2 Quality index of the dimension
Personnel’s skills
 LS  LW
QId3 Quality index of the dimension
Dispensing process
 LS  LW
6
i 4
i
i
9
i 7
i
i
We evaluated the correlation between GLS and GQI of the respondents
and between LSdi and QIdi.
Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale
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
Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale
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
Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale
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%)
Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale
ISAHP 2011
AHP-based index
Level of Satisfaction
#
GQI: Global Quality Index
GLS: Global Level of Satisfaction 22
Correlation
coefficient
0.5164
p-value
0.014
QId1: Quality Index referred LSd1: Level of Satisfaction
to Facilities
referred to Facilities
29
0.8285
<0.001
QId2: Quality Index referred LSd2: Level of Satisfaction
to Personnel’s skills
referred to Personnel’s skills
42
0.5650
<0.001
QId3: Quality Index referred LSd3: Level of Satisfaction 32
to Dispensing process
referred to Dispensing process
0.3649
0.040
The correlations were significant for all indexes (p-value <0.05)
Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale
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).
Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale
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
Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale