Identifying Root Causes of Important Service Failures across Medical Examination Processes with Integration of 4M1E, ITLV, GRA, DEMATEL and FMEA.

Medical examination plays an essential role in most medical treatment processes, and thus, the quality of service relevant to medical examination has great impact on patient satisfaction. The targeted hospital has long been faced with the problem that patient satisfaction of its medical examination department is below average. An assessment model, integrating 4M1E, ITLV, GRA, DEMATEL and FMEA, was developed in this study to identify the root causes of important service failures across medical examination processes, where (1) a cause-and-effect diagram was enhanced with 4M1E, identifying the list of failure modes relevant to service quality over the medical examination process with the 4M1E analysis framework, (2) FMEA experts were enabled to report their assessment results in their preferred ways by using the ITLV scheme, (3) causes of failure to failure modes with was figured out with DEMATEL, and (4) the evaluation results were improved by integrating GRA. Experimental results obtained by the proposed approach are compared with several benchmarks, and it was observed that (1) the results obtained by the proposed model are more suitable when FMEA experts prefer using different assessment languages versus other approaches; (2) the proposed model can figure out the key root causes according to their impact on overall failure modes.