Integration of fuzzy set theory and TOPSIS into HFMEA to improve outpatient service for elderly patients in Taiwan

Background: Taiwan became a World Health Organization-defined aging country in 1993, and it is estimated to become an aged country by 2017, surpassing Japan as the fastest aging country in the world. However, healthcare services in Taiwan need a wide range of improvements to cope with the challenges of population aging.

Methods: Healthcare failure mode and effects analysis (HFMEA) developed by the Department of Veterans Affairs' National Center for Patient Safety (NCPS) was used to evaluate the inconvenience of outpatient registration process for elderly patients. Also, fuzzy set theory was used along with technique for order preference by similarity to ideal solution (TOPSIS) method in multiple criteria decision making (MCDM) to rank the failure risks in the HFMEA.

Results: The top three failure modes ranked by the TOPSIS method were "short consultation time," "possible complications of the checkup or treatment were not told," and "opinions and feelings of patients and relatives were not respected." Based on those failure modes, improvements were proposed and results were feedback to hospitals. A random sample of 40 elderly patients was selected for interview at the outpatient department of a tertiary medical center in Taiwan. Thirty-seven out of the 40 elderly patients (92.5%) agreed with the executive expert team. This meant the improvement proposals were effective.

Conclusion: In this study, HFMEA was extended to explore the impacts of geriatric outpatient service process failures on elderly patients. Using fuzzy set theory and the TOPSIS method in multiple criteria decision making to rank the severity of the failure modes, the risk assessment of the geriatric outpatient service process was more objective when analyzed with quantitative data.