Abstract - This study develops an integrated model to improve performance evaluation in the hospitals. In this paper we show the use of the Compromise Ranking Method, also known as the VIKOR method, in the performance evaluation of nurses’ competency. The method is improved by introducing the fuzzy TOPSIS for assigning the weights of relative importance of attributes. The study thus presents a complete assessment model that helps managers to identify items for improvement, while simultaneously promoting cost and time efficiencies in nurses’ competency.
Keywords - Fuzzy Set, Nurses’ Competency,
TOPSIS, VIKOR,
I. INTRODUCTION
Along with increasingly complex clinical nursing care requirements, comes an increasing demand for high-quality manpower [1]. Many nursing skills need to be learnt on the job. The ability of hospitals to accurately assess and manage nurses depends on the correct adjustments to increase work loads, along with appropriate education and training programs. This will help to stabilize the phenomena of a high turnover rate, particularly among new staff nurses, who often leave temporarily or permanently due to frustration [2].
The problem of the complexity of performance evaluation makes the development and the application of standard models more difficult, while at the same time actually presents a motivation for the development of new, more flexible models, which, again, can be adapted to specific interest positions of those who compare the banks. The paper shows the VIKOR and fuzzy TOPSIS method is very appropriate for the development of such models. It is of special interest that this method provides the development of the multi-criteria evaluation models.
The development of clinical skills and competencies are given a central role throughout the college education
of nurses. These skills include: nursing skills, knowledge, attitudes and performance ability [3]. Due to the characteristics and working environments of different
nursing units and cultures, the definitions of nursing skills vary. This adds to the complexity of developing a skills
assessment performance tool [4]. Especially in medical centers, as the severity and complexity of patients’ conditions are more serious than those of patients at regional or district hospitals – training requirements for medical center capabilities are greater. In recent years the clinical skills of nurses are the standard used to measure medical care, hiring and performance evaluation.
Competence refers to an individual’s overall ability. Competence includes technical skill in professional practice, as well as attributes such as: attitude, values, judgmental ability and personal disposition. Competency is a measure of an individual’s particular skill or specialization [5]. Differentiation between the terms competence and competency are not clearly understood and are often used interchangeably in literature [6]. Nursing ability is assessed mainly based on their clinical performance, whilst nurses’ non-technical attributes are overlooked. This results in complaints from patients and their families. Therefore a complete nursing assessment needs to be implemented, which includes: relevant clinical skills, knowledge, attitude and all factors that measure a nurse’s overall competency [7].
In many countries nursing students and new staff nurses receive senior RN training and instruction [8]. This skills assessment does not provide a comprehensive evaluation strategy, as it neglects the feedback of students in the process. This results in disparities between the skills nurses learn and their on the job performance [9].
II. METHODOLOGY
A. Participants
The primary participants in this study were emergency department (ED) paramedics in hospitals because their jobs are fairly difficult and require a higher level of immediate reaction and more proficient skills than nursing personnel in other departments. We used the simple random sampling method to select survey candidates and distributed questionnaires to ED paramedics in three age groups: 22 to 29 years old, 30 to 39 years old, and 40 years old and above.
B. Questionnaire design
The questionnaire was developed based on the KSAO model proposed by Catano [10]. The primary objective of this questionnaire is to understand the competency of each paramedic. The questionnaire used the 5-point Likert scale to assess the competency characteristics of paramedics. Survey participants provided ratings according to their degree of agreement with each question item. Ratings were as follows: 1 point for strongly disagree, 2 points for disagree, 3 points for neutral, 4 points for agree, and 5 points for strongly agree.(see Table.1)
C. Fuzzy TOPSIS and VIKOR Methods
The VIKOR method was developed for multi-criteria optimization of complex systems. It is an effective technique for multi-criteria analysis and has been widely applied in compromise ranking problems in business management. There are also many researches adopt the VIKOR model to investigate the complex managerial problems. Sayadi et al. [11] extended the VIKOR method for decision making problems with interval number. Büyüközkan & Ruan [12] applied VIKOR method to evaluate of software development projects. Chu et al. [13] to demonstrate the anticipated achievements of knowledge communities (KC) through simple average weight (SAW), “Technique for Order Preference by Similarity to an Ideal Solution” and “VlseKriterijumska Optimizacija I Kompromisno Resenje” (VIKOR). Opricovic & Tzeng [14] compared with four multicriteria decision making methods: TOPSIS, PROMETHEE, ELECTRE, and VIKOR and find out the best method evaluation method is VIKOR. Tzeng et al. [15] applied TOPSIS and VIKOR to determine the best compromise alternative fuel mode. Opricovic & Tzeng [14] tried to reveal and to compare the procedural basis of these two MCDM methods, TOPSIS and VIKOR
III. RESULTS
A. Determine the linguistic weighting of each criteria
We adopt Fuzzy TOPSIS method to evaluate the weights of different criteria. Following the construction of Fuzzy TOPSIS model, it is extremely important that experts fill the judgment matrix. From the viewpoint of expert validity, the buildup of most of the operationalizations was based on the literature that caused them to have expert validity.
B. Weighting each criterion by VIKOR
Table II shows the relative weight of 12 factor of the competitive advantage for hospital, which obtained by Fuzzy TOPSIS method. The weights for each criterion are: C1 (0.677), C2 (0.833), C3 (0.833), C4 (0.730), C5 (0.670), C6 (0.687), C7 (0.573), C8 (0.713), C9 (0.733), C10 (0.557), C11 (0.497) and C12 (0.577). From the Fuzzy TOPSIS results, we can understand the first two important factors for the competitive advantage of shopping websites are C2 (0.833) and C3 (0.833). Moreover, the less important factor is C11 (0.497).
TABLE. I
Definition of job competency assessment criteria for paramedics
General Goal / First Level Assessment Criteria / Second Level Assessment Criteria / Definition of Assessment CriteriaJob competency of paramedics / Knowledge（K） / Education level / Graduate of domestic and international nursing school
Work experience / Actual years of experience in nursing practices
Skill（S） / Professional skills / Accuracy, integrity, and consistency of nursing practices
Independent skills / Completes nursing jobs independently
Interpersonal skills / Interacts well with other people or in groups
Ability（A） / Communication ability / Effective communication with people or groups
Innovative ability / Improves nursing procedures or rules to enhance work efficiency
Teamwork and corporative spirit / Cooperates with others to complete tasks
Other Characteristics（O） / Agreeable / Easygoing and empathizes with others
Diligent and forthright / Able to complete the tasks delegated or assigned by others
Outgoing / Has confidence and negotiation abilities
Emotionally sensitive / Demonstrates perceptive reactions
Open minded / Creative and optimistic
TABLE II
Linguistic scales for the importance of each criterion
Linguistic variable / Corresponding triangular fuzzy numberVery low (VL) / (0.0,0.1,0.3)
Low (L) / (0.1,0.3,0.5)
Medium (M) / (0.3,0.5,0.7)
High (H) / (0.5,0.7,0.9)
Very High (VH) / (0.7,0.9,1.0)
TABLE III
Weights of each criterion
BNP / RankingC1 / (0.48,0.68,0.87) / 0.677 / 7
C2 / (0.66,0.86,0.98) / 0.833 / 1
C3 / (0.66,0.86,0.98) / 0.833 / 1
C4 / (0.54,0.74,0.91) / 0.730 / 4
C5 / (0.48,0.68,0.85) / 0.670 / 8
C6 / (0.50,0.70,0.86) / 0.687 / 6
C7 / (0.38,0.58,0.76) / 0.573 / 10
C8 / (0.52,0.72,0.90) / 0.713 / 5
C9 / (0.54,0.74,0.92) / 0.733 / 3
C10 / (0.36,0.56,0.75) / 0.557 / 11
C11 / (0.30,0.50,0.69) / 0.497 / 12
C12 / (0.38,0.58,0.77) / 0.577 / 9
C. Estimating the best performance model
We evaluate six hospitals’ performance with the
consensus weights of criteria identified before, and find out each hospital’s performance(Table.IV) and normalized the results(Table.V)
The value of Sk and Qk are shown as Table V. In this case, we set up the values S* and Q* as 0, the values S- and Q- as 1, so as to obtain the absolute relations for the index values Rk.
In order to understand how the Rk of each objective is affected by V(0≦V≦1), this study respectively adopts v = 0, v = 0.5, v = 1 to compare these index values Rk for the control objectives before and after implementation and presents them in Table V
IV. DISCUSSION
As mentioned earlier a combination of capabilities such as, technical skill, knowledge, attitude, level of work quality, efficiency and work performance are all influential. Assessment of nursing skills and on the job performance, are very important. Through accurate appraisal, nursing executives can develop training programs to improve patient safety and care. More complex duties such as advanced nursing (Advance Practice Nursing APN), anesthesia nursing, in patient care assessment and communication; counseling, research, ethical decision-making and leadership are also performance assessment factors [16] and [17].
In our analysis, nursing supervisors consider past experience, professional skill, patient first value, plus the ability to work both independently and as a team member the most important factors. Skills such as reading biochemical test results for specific patients and other medical information, using evidence-based medicine, PubMed and other databases of secondary data, enable nurses to provide a specialized care plan for patients, ensuring proper use of equipment with technical medical equipment to monitor changes in a patient’s condition and ensure accurate records are kept. Professional standards which are continuously upgraded and updated, along with the upgrading of standard care will enable nursing staff to deal with families of patients and patient consultation. This will provide a more positive, rather than defensive response when they answer patients’ questions [18] and [19].
Team spirit and a strong patient first value have a remarkable positive effect on the psychological, social and physical needs of patients, as part of a multidisciplinary approach to planning and delivery of care - which is the most important factor of nursing performance [20]. Nurses are the front line of hospital care providing patients with information and care, and can improve the efficiency of professional care programs. Nurses interact with other nurses and doctors, so a comprehensive integrated service can be provided. Therefore interpersonal communication skills and clinical care have a significant correlation [21].
TABLE IV
The gap-values of six hospitals
CriteriaC1 / C2 / C3 / C4 / C5 / C6 / C7 / C8 / C9 / C10 / C11 / C12
Alternatives / A1 / 4.3 / 4.2 / 4.3 / 4 / 3.7 / 4.1 / 3.6 / 4.2 / 3.8 / 3.6 / 3.2 / 3.6
A2 / 3.4 / 3.6 / 3.8 / 3.6 / 4 / 3.9 / 3.5 / 3.8 / 3.5 / 3.5 / 3.4 / 3
A3 / 4.1 / 3.8 / 4.1 / 3.8 / 3.9 / 3.9 / 3.8 / 3.9 / 3.3 / 3.5 / 3.2 / 3.3
A4 / 3 / 3.3 / 3.4 / 3.1 / 3.5 / 3.6 / 3.5 / 3.2 / 3.5 / 3.3 / 3.1 / 3.1
A5 / 2.8 / 3.3 / 3.4 / 3.2 / 3.4 / 3.4 / 3.2 / 3.7 / 3.5 / 3.1 / 3 / 2.9
A6 / 3.1 / 3.4 / 3.2 / 3.6 / 3.1 / 3.3 / 3.1 / 3.6 / 2.8 / 3.1 / 2.8 / 2.9
TABLE V
Normalized gap-values of six hospitals
CriteriaC1 / C2 / C3 / C4 / C5 / C6 / C7 / C8 / C9 / C10 / C11 / C12
Alternatives / A1 / 18.49 / 17.64 / 18.49 / 16.00 / 13.69 / 16.81 / 12.96 / 17.64 / 14.44 / 12.96 / 10.24 / 12.96
A2 / 11.56 / 12.96 / 14.44 / 12.96 / 16.00 / 15.21 / 12.25 / 14.44 / 12.25 / 12.25 / 11.56 / 9.00
A3 / 16.81 / 14.44 / 16.81 / 14.44 / 15.21 / 15.21 / 14.44 / 15.21 / 10.89 / 12.25 / 10.24 / 10.89
A4 / 9.00 / 10.89 / 11.56 / 9.61 / 12.25 / 12.96 / 12.25 / 10.24 / 12.25 / 10.89 / 9.61 / 9.61
A5 / 7.84 / 10.89 / 11.56 / 10.24 / 11.56 / 11.56 / 10.24 / 13.69 / 12.25 / 9.61 / 9.00 / 8.41
A6 / 9.61 / 11.56 / 10.24 / 12.96 / 9.61 / 10.89 / 9.61 / 12.96 / 7.84 / 9.61 / 7.84 / 8.41
TABLE VI
Comparison of value Rk of six hospitals according to (v=0), (v=0.5), (v=1)
Average gap-valuesSk
(V＝1) / Compromise gap-values
(Sk + Qk)/2
(V＝0.5) / Max gap-values
Qk
(V＝0)
Alternatives / A1 / 0.000 (6) / 0.000 (6) / 0.0000 (6)
A2 / 0.940 (4) / 0.470 (4) / 0.0000 (4)
A3 / 0.419 (5) / 0.209 (5) / 0.0000 (5)
A4 / 1.799 (3) / 0.900 (3) / 0.0000 (3)
A5 / 1.900 (2) / 0.950 (2) / 0.0000 (2)
A6 / 2.000 (1) / 1.000 (1) / 0.0000 (1)
V. CONCLUSION