, 44:55 | Cite as

A Fuzzy Decision-Making Trial and Evaluation Laboratory approach to analyse risk factors related to environmental health and safety aspects in the healthcare industry

  • S BATHRINATHEmail author


In healthcare firms, environmental health and safety (EHS) remains as a vital factor as healthcare products pose very intricate problems related to environment safety. The different similar and dissimilar risk factors that prevail in the system have complicated known and unknown causal relationships that are difficult to understand and interpret. Hence, improving the EHS remains as a challenge in healthcare industry. A research study is carried out utilizing the data (in conjunction with expert’s opinion) and conditions of a healthcare firm in India to categorize and obtain the prominent risk factors based on identifying the most adverse causal relationship among them. A Fuzzy Decision-Making Trial and Evaluation Laboratory (fuzzy DEMATEL)-based approach is designed and employed to assess and rank different EHS risk factors. The trapezoidal fuzzy membership function of the model facilitates better learning of interrelationships in spite of the prevailing vagueness in the causal relationships between the risk factors. The outcomes (the decisive risk factors) out of the experimentation using the proposed methodology strongly coincide with the actual causes of the EHS factors during the last one decade. As the proposed approach is found to be very effective in fixing the causal relationships and ranking among the risk factors, this may be successfully employed in similar healthcare firms/industries for finding out their respective decisive risk factors.


Fuzzy DEMATEL EHS healthcare risk factors India 


  1. 1.
    Kamath K, Shabaraya A R and Subramanyam E V S 2014 Role of environment health and safety (EHS) in pharmaceutical industry, vol. 46, pp. 34–35Google Scholar
  2. 2.
    Bond R G, Michaelsen G S and Deroos R (Eds.) 1973 Environmental health and safety in health-care facilities Google Scholar
  3. 3.
    Bourbonnais R, Brisson C, Vinet A, Vézina M and Lower A 2006 Development and implementation of a participative intervention to improve the psychosocial work environment and mental health in an acute care hospital. Occupational and Environmental Medicine 63(5): 326–334CrossRefGoogle Scholar
  4. 4.
    Lundstrom T, Pugliese G, Bartley J, Cox J and Guither C 2002 Organizational and environmental factors that affect worker health and safety and patient outcomes. American Journal of Infection Control 30(2): 93–106CrossRefGoogle Scholar
  5. 5.
    Nieva V F and Sorra J 2003 Safety culture assessment: a tool for improving patient safety in healthcare organizations. BMJ Quality & Safety 12(Suppl 2): ii17–ii23Google Scholar
  6. 6.
    Baicker K, Cutler D and Song Z 2010 Workplace wellness programs can generate savings. Health Affairs 29(2): 304–311CrossRefGoogle Scholar
  7. 7.
    Govindarajulu N and Daily B F 2004 Motivating employees for environmental improvement. Industrial Management & Data Systems 104(4): 364–372CrossRefGoogle Scholar
  8. 8.
    Hignett S, Fray M, Rossi M A, Tamminen-Peter L, Hermann S, Lomi C and Johnsson C 2007 Implementation of the Manual Handling Directive in the healthcare industry in the European Union for patient handling tasks. International Journal of Industrial Ergonomics 37(5): 415–423CrossRefGoogle Scholar
  9. 9.
    Duijm N J, Fiévez C, Gerbec M, Hauptmanns U and Konstandinidou M 2008 Management of health, safety and environment in process industry. Safety Science 46(6): 908–920CrossRefGoogle Scholar
  10. 10.
    Phimister J R, Oktem U, Kleindorfer P R and Kunreuther H 2003 Near miss incident management in the chemical process industry. Risk Analysis 23(3): 445–459CrossRefGoogle Scholar
  11. 11.
    Shen L Y and Tam V W 2002 Implementation of environmental management in the Hong Kong construction industry. International Journal of Project Management 20(7): 535–543CrossRefGoogle Scholar
  12. 12.
    Lee J, Mahendra S and Alvarez P J 2010 Nanomaterials in the construction industry: a review of their applications and environmental health and safety considerations. ACS Nano 4(7): 3580–3590CrossRefGoogle Scholar
  13. 13.
    Ilangkumaran M, Karthikeyan M, Ramachandran T, Boopathiraja M and Kirubakaran B 2015 Risk analysis and warning rate of hot environment for foundry industry using hybrid MCDM technique. Safety Science 72: 133–143CrossRefGoogle Scholar
  14. 14.
    Reyes J P, San-José J T, Cuadrado J and Sancibrian R 2014 Health & Safety criteria for determining the sustainable value of construction projects. Safety Science 62: 221–232CrossRefGoogle Scholar
  15. 15.
    Hatami-Marbini A, Tavana M, Moradi M and Kangi F 2013 A fuzzy group Electre method for safety and health assessment in hazardous waste recycling facilities. Safety Science 51(1): 414–426CrossRefGoogle Scholar
  16. 16.
    Jozi S A, Shoshtary M T and Zadeh A R K 2015 Environmental risk assessment of dams in construction phase using a multi-criteria decision-making (MCDM) method. Human and Ecological Risk Assessment: An International Journal 21(1): 1–16CrossRefGoogle Scholar
  17. 17.
    Zheng G, Zhu N, Tian Z, Chen Y and Sun B 2012 Application of a trapezoidal fuzzy AHP method for work safety evaluation and early warning rating of hot and humid environments. Safety Science 50(2): 228–239CrossRefGoogle Scholar
  18. 18.
    Gupta V K and Thakkar J J 2018 A quantitative risk assessment methodology for construction project. Sādhanā 43(7): 116CrossRefGoogle Scholar
  19. 19.
    Rajak A K, Niraj M and Kumar S 2016 Designing of fuzzy expert heuristic models with cost management toward coordinating AHP, fuzzy TOPSIS and FIS approaches. Sādhanā 41(10): 1209–1218MathSciNetzbMATHGoogle Scholar
  20. 20.
    Messelbeck J and Whaley M 1999 Greening the health care supply chain: triggers of change, models for success. Corporate Environmental Strategy 6(1): 39–45CrossRefGoogle Scholar
  21. 21.
    Roberts V 2001 Managing strategic outsourcing in the healthcare industry. Journal of Healthcare Management 46: 239–249CrossRefGoogle Scholar
  22. 22.
    Hale A R and Hovden J 1998 Management and culture: the third age of safety. A review of approaches to organizational aspects of safety, health and environment. Occupational injury: risk, prevention and intervention, pp. 129–165Google Scholar
  23. 23.
    Kagermann H 2015 Change through digitization—value creation in the age of industry 4.0. In: Management of permanent change. Wiesbaden: Springer Gabler, pp. 23–45Google Scholar
  24. 24.
    Lam C W, James J T, McCluskey R, Arepalli S and Hunter R L 2006 A review of carbon nanotube toxicity and assessment of potential occupational and environmental health risks. Critical Reviews in Toxicology 36(3): 189–217CrossRefGoogle Scholar
  25. 25.
    Koller G, Fischer U and Hungerbühler K 2000 Assessing safety, health, and environmental impact early during process development. Industrial & Engineering Chemistry Research 39(4): 960–972CrossRefGoogle Scholar
  26. 26.
    Marx D A and Slonim A D 2003 Assessing patient safety risk before the injury occurs: an introduction to sociotechnical probabilistic risk modelling in health care. BMJ Quality & Safety 12(Suppl 2): ii33–ii38Google Scholar
  27. 27.
    Bates D W, Saria S, Ohno-Machado L, Shah A and Escobar G 2014 Big data in health care: using analytics to identify and manage high-risk and high-cost patients. Health Affairs 33(7): 1123–1131CrossRefGoogle Scholar
  28. 28.
    Sauter S L, Murphy L R and Hurrell J J 1990 Prevention of work-related psychological disorders: a national strategy proposed by the National Institute for Occupational Safety and Health (NIOSH). American Psychologist 45(10): 1146CrossRefGoogle Scholar
  29. 29.
    Quinlan R J 2007 Human parental effort and environmental risk. Proceedings of the Royal Society of London B: Biological Sciences 274(1606): 121–125CrossRefGoogle Scholar
  30. 30.
    Betancourt J R, Green A R, Carrillo J E and Owusu Ananeh-Firempong I I 2016 Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports 118(4): 293–302CrossRefGoogle Scholar
  31. 31.
    Plog B A, Niland J and Quinlan P 1996 Fundamentals of industrial hygiene. Ithaca, NY: National Safety Council, pp. 1–7Google Scholar
  32. 32.
    Stern P C, Dietz T and Black J S 1985 Support for environmental protection: the role of moral norms. Population and Environment 8(3–4): 204–222CrossRefGoogle Scholar
  33. 33.
    Begun J W, Zimmerman B and Dooley K 2003 Health care organizations as complex adaptive systems. Advances in health care organization theory, pp. 253, 288Google Scholar
  34. 34.
    Morrow D and Rondinelli D 2002 Adopting corporate environmental management systems: motivations and results of ISO 14001 and EMAS certification. European Management Journal 20(2): 159–171CrossRefGoogle Scholar
  35. 35.
    Judge W Q and Ryman J A 2001 The shared leadership challenge in strategic alliances: lessons from the US healthcare industry. The Academy of Management Executive 15(2): 71–79Google Scholar
  36. 36.
    Lundgren R E and McMakin A H 2018 Risk communication: a handbook for communicating environmental, safety, and health risks. John Wiley & SonsGoogle Scholar
  37. 37.
    Reynolds B and Seeger M W 2005 Crisis and emergency risk communication as an integrative model. Journal of Health Communication 10(1): 43–55CrossRefGoogle Scholar
  38. 38.
    Wisner B and Adams J (Eds.) 2002 Environmental health in emergencies and disasters: a practical guide. Geneva: World Health OrganizationGoogle Scholar
  39. 39.
    Kawakami T, Kogi K, Toyama N and Yoshikawa T 2004 Participatory approaches to improving safety and health under trade union initiative. Industrial Health 42(2): 196–206CrossRefGoogle Scholar
  40. 40.
    Zadeh L A 1965 Information and control. Fuzzy Sets 8(3): 338–353CrossRefGoogle Scholar
  41. 41.
    Luthra S, Govindan K, Kharb R K and Mangla S K 2016 Evaluating the enablers in solar power developments in the current scenario using fuzzy DEMATEL: an Indian perspective. Renewable and Sustainable Energy Reviews 63: 379–397CrossRefGoogle Scholar
  42. 42.
    Altuntas S, Selim, H and Dereli T 2014 A fuzzy DEMATEL-based solution approach for facility layout problem: a case study. The International Journal of Advanced Manufacturing Technology 73(5–8): 749–771CrossRefGoogle Scholar
  43. 43.
    Patil S K and Kant R 2014 A fuzzy AHP–TOPSIS framework for ranking the solutions of Knowledge Management adoption in Supply Chain to overcome its barriers. Expert Systems with Applications 41(2): 679–693CrossRefGoogle Scholar
  44. 44.
    Sangaiah A K, Gopal J, Basu A and Subramaniam P R 2017 An integrated fuzzy DEMATEL, TOPSIS, and ELECTRE approach for evaluating knowledge transfer effectiveness with reference to GSD project outcome. Neural Computing and Applications 28(1): 111–123CrossRefGoogle Scholar
  45. 45.
    Govindan K, Kannan D and Shankar K M 2014 Evaluating the drivers of corporate social responsibility in the mining industry with multi-criteria approach: a multi-stakeholder perspective. Journal of Cleaner Production 84: 214–232CrossRefGoogle Scholar
  46. 46.
    Chang B, Chang C W and Wu C H 2011 Fuzzy DEMATEL method for developing supplier selection criteria. Expert Systems with Applications 38(3): 1850–1858CrossRefGoogle Scholar
  47. 47.
    Zhou Q, Huang W and Zhang, Y. 2011 Identifying critical success factors in emergency management using a fuzzy DEMATEL method. Safety Science 49(2): 243–252CrossRefGoogle Scholar
  48. 48.
    BaykasoğLu A, KaplanoğLu V, DurmuşOğLu Z D and Şahin C 2013 Integrating fuzzy DEMATEL and fuzzy hierarchical TOPSIS methods for truck selection. Expert Systems with Applications 40(3): 899–907CrossRefGoogle Scholar
  49. 49.
    Lin R J 2013 Using fuzzy DEMATEL to evaluate the green supply chain management practices. Journal of Cleaner Production 40: 32–39CrossRefGoogle Scholar
  50. 50.
    Tseng M L and Lin Y H 2009 Application of fuzzy DEMATEL to develop a cause and effect model of municipal solid waste management in Metro Manila. Environmental Monitoring and Assessment 158(1–4): 519CrossRefGoogle Scholar
  51. 51.
    Tadić S, Zečević S and Krstić M 2014 A novel hybrid MCDM model based on fuzzy DEMATEL, fuzzy ANP and fuzzy VIKOR for city logistics concept selection. Expert Systems with Applications 41(18): 8112–8128CrossRefGoogle Scholar
  52. 52.
    Govindan K, Khodaverdi R and Vafadarnikjoo A 2015 Intuitionistic fuzzy based DEMATEL method for developing green practices and performances in a green supply chain. Expert Systems with Applications 42(20): 7207–7220CrossRefGoogle Scholar

Copyright information

© Indian Academy of Sciences 2019

Authors and Affiliations

  1. 1.Department of Mechanical EngineeringKalasalingam Academy of Research and EducationKrishnankoilIndia
  2. 2.Faculty of Manufacturing EngineeringUniversiti MalaysiaPekan, PahangMalaysia

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