Productivity growth and efficiency measurements in fuzzy environments with an application to health care

Health care organizations must continuously improve their productivity to sustain long-term growth and profitability. Sustainable productivity performance is mostly assumed to be a natural outcome of successful health care management. Data envelopment analysis (DEA) is a popular mathematical programming method for comparing the inputs and outputs of a set of homogenous decision making units (DMUs) by evaluating their relative efficiency. The Malmquist productivity index (MPI) is widely used for productivity analysis by relying on constructing a best practice frontier and calculating the relative performance of a DMU for different time periods. The conventional DEA requires accurate and crisp data to calculate the MPI. However, the real-world data are often imprecise and vague. In this study, the authors propose a novel productivity measurement approach in fuzzy environments with MPI. An application of the proposed approach in health care is presented to demonstrate the simplicity and efficacy of the procedures and algorithms in a hospital efficiency study conducted for a State Office of Inspector General in the United States. © 2012, IGI Global.

Reliability of vegetation community information derived using decorana ordination and fuzzy c-means clustering

Descriptions of vegetation communities are often based on vague semantic terms describing species presence and dominance. For this reason, some researchers advocate the use of fuzzy sets in the statistical classification of plant species data into communities. In this study, spatially referenced vegetation abundance values collected from Greek phrygana were analysed by ordination (DECORANA), and classified on the resulting axes using fuzzy c-means to yield a point data-set representing local memberships in characteristic plant communities. The fuzzy clusters matched vegetation communities noted in the field, which tended to grade into one another, rather than occupying discrete patches. The fuzzy set representation of the community exploited the strengths of detrended correspondence analysis while retaining richer information than a TWINSPAN classification of the same data. Thus, in the absence of phytosociological benchmarks, meaningful and manageable habitat information could be derived from complex, multivariate species data. We also analysed the influence of the reliability of different surveyors' field observations by multiple sampling at a selected sample location. We show that the impact of surveyor error was more severe in the Boolean than the fuzzy classification. © 2007 Springer.

Unsupervised KDD to creatively support managers' decision making with fuzzy association rules:a distribution channel application

To be competitive in contemporary turbulent environments, firms must be capable of processing huge amounts of information, and effectively convert it into actionable knowledge. This is particularly the case in the marketing context, where problems are also usually highly complex, unstructured and ill-defined. In recent years, the development of marketing management support systems has paralleled this evolution in informational problems faced by managers, leading to a growth in the study (and use) of artificial intelligence and soft computing methodologies. Here, we present and implement a novel intelligent system that incorporates fuzzy logic and genetic algorithms to operate in an unsupervised manner. This approach allows the discovery of interesting association rules, which can be linguistically interpreted, in large scale databases (KDD or Knowledge Discovery in Databases.) We then demonstrate its application to a distribution channel problem. It is shown how the proposed system is able to return a number of novel and potentially-interesting associations among variables. Thus, it is argued that our method has significant potential to improve the analysis of marketing and business databases in practice, especially in non-programmed decisional scenarios, as well as to assist scholarly researchers in their exploratory analysis. © 2013 Elsevier Inc.

Logics of marginalisation in health and social care reform:integration, choice, and provider-blind provision

The period 2010–2013 was a time of far-reaching structural reforms of the National Health Service in England. Of particular interest in this paper is the way in which radical critiques of the reform process were marginalised by pragmatic concerns about how to maintain the market-competition thrust of the reforms while avoiding potential fragmentation. We draw on the Essex school of political discourse theory and develop a ‘nodal’ analytical framework to argue that widespread and repeated appeals to a narrative of choice-based integrated care served to take the fragmentation ‘sting’ out of radical critiques of the pro-competition reform process. This served to marginalise alternative visions of health and social care, and to pre-empt the contestation of a key norm in the provision of health care that is closely associated with the notions of ‘any willing provider’ and ‘any qualified provider’: provider-blind provision.

A fuzzy expected value approach under generalized data envelopment analysis

Fuzzy data envelopment analysis (DEA) models emerge as another class of DEA models to account for imprecise inputs and outputs for decision making units (DMUs). Although several approaches for solving fuzzy DEA models have been developed, there are some drawbacks, ranging from the inability to provide satisfactory discrimination power to simplistic numerical examples that handles only triangular fuzzy numbers or symmetrical fuzzy numbers. To address these drawbacks, this paper proposes using the concept of expected value in generalized DEA (GDEA) model. This allows the unification of three models - fuzzy expected CCR, fuzzy expected BCC, and fuzzy expected FDH models - and the ability of these models to handle both symmetrical and asymmetrical fuzzy numbers. We also explored the role of fuzzy GDEA model as a ranking method and compared it to existing super-efficiency evaluation models. Our proposed model is always feasible, while infeasibility problems remain in certain cases under existing super-efficiency models. In order to illustrate the performance of the proposed method, it is first tested using two established numerical examples and compared with the results obtained from alternative methods. A third example on energy dependency among 23 European Union (EU) member countries is further used to validate and describe the efficacy of our approach under asymmetric fuzzy numbers.

Assessing productive efficiency of banks using integrated Fuzzy-DEA and bootstrapping:a case of Mozambican banks

Performance analysis has become a vital part of the management practices in the banking industry. There are numerous applications using DEA models to estimate efficiency in banking, and most of them assume that inputs and outputs are known with absolute precision. Here, we propose new Fuzzy-DEA α-level models to assess underlying uncertainty. Further, bootstrap truncated regressions with fixed factors are used to measure the impact of each model on the efficiency scores and to identify the most relevant contextual variables on efficiency. The proposed models have been demonstrated using an application in Mozambican banks to handle the underlying uncertainty. Findings reveal that fuzziness is predominant over randomness in interpreting the results. In addition, fuzziness can be used by decision-makers to identify missing variables to help in interpreting the results. Price of labor, price of capital, and market-share were found to be the significant factors in measuring bank efficiency. Managerial implications are addressed.

Carbon efficiency evaluation:an analytical framework using fuzzy DEA

Data Envelopment Analysis (DEA) is a powerful analytical technique for measuring the relative efficiency of alternatives based on their inputs and outputs. The alternatives can be in the form of countries who attempt to enhance their productivity and environmental efficiencies concurrently. However, when desirable outputs such as productivity increases, undesirable outputs increase as well (e.g. carbon emissions), thus making the performance evaluation questionable. In addition, traditional environmental efficiency has been typically measured by crisp input and output (desirable and undesirable). However, the input and output data, such as CO2 emissions, in real-world evaluation problems are often imprecise or ambiguous. This paper proposes a DEA-based framework where the input and output data are characterized by symmetrical and asymmetrical fuzzy numbers. The proposed method allows the environmental evaluation to be assessed at different levels of certainty. The validity of the proposed model has been tested and its usefulness is illustrated using two numerical examples. An application of energy efficiency among 23 European Union (EU) member countries is further presented to show the applicability and efficacy of the proposed approach under asymmetric fuzzy numbers.

Identifying the configurational paths to innovation in SMEs:a fuzzy-set qualitative comparative analysis

Using fuzzy-set qualitative comparative analysis (fsQCA), this study investigates the conditions leading to a higher level of innovation. More specifically, the study explores the impact of inter-organisational knowledge transfer networks and organisations' internal capabilities on different types of innovation in Small to Medium size Enterprises (SMEs) in the high-tech sector. A survey instrument was used to collect data from a sample of UK SMEs. The findings show that although individual factors are important, there is no need for a company to perform well in all the areas. The fsQCA, which enables the examination of the impacts of different combinations of factors, reveals that there are a number of paths to achieve better incremental and radical innovation performance. Companies need to choose the one that is closest to their abilities and fits best with their resources.

Fuzzy c-means variants for medical image segmentation

Segmentation is an important step in many medical imaging applications and a variety of image segmentation techniques exist. One group of segmentation algorithms is based on clustering concepts. In this article we investigate several fuzzy c-means based clustering algorithms and their application to medical image segmentation. In particular we evaluate the conventional hard c-means (HCM) and fuzzy c-means (FCM) approaches as well as three computationally more efficient derivatives of fuzzy c-means: fast FCM with random sampling, fast generalised FCM, and a new anisotropic mean shift based FCM. © 2010 by IJTS, ISDER.

Modulating membership grades to gain consensus for fuzzy set uncertainty values in a clinical decision support system

This paper deals with a very important issue in any knowledge engineering discipline: the accurate representation and modelling of real life data and its processing by human experts. The work is applied to the GRiST Mental Health Risk Screening Tool for assessing risks associated with mental-health problems. The complexity of risk data and the wide variations in clinicians' expert opinions make it difficult to elicit representations of uncertainty that are an accurate and meaningful consensus. It requires integrating each expert's estimation of a continuous distribution of uncertainty across a range of values. This paper describes an algorithm that generates a consensual distribution at the same time as measuring the consistency of inputs. Hence it provides a measure of the confidence in the particular data item's risk contribution at the input stage and can help give an indication of the quality of subsequent risk predictions. © 2010 IEEE.