A Framework for Improving Patient Satisfaction by Reducing the Length of Stay in The Operation Suite Using the Combined DEMATEL-ANP Model





Patients' length of stay, Operating suite, Patient satisfaction, DEMATEL, ANP


Operating room (OR) planning has gradually become an important element of Hospital administration in recent years. The OR performance plays a significant role in enhancing the quality of the care provided to the patients and reducing patients' length of stay (LOS), which is the function of the OR performance, decreasing costs. Following a survey of the existing research and conducted interviews with clinical and non-clinical OR staff, there are several factors influencing patients’ length of stay (LOS) in the OR and, consequently, the costs of the OR. In this work, first, we implemented the DEMATEL to define the relationship between OR factors, next, employed ANP to identify the most influential factors on the LOS in the OR. The results show the most influential factors are operative time, operative setup, patient waiting time, anesthesia, and patient preparation. Running two rooms concurrently and minimizing turnover time (TOT) reduce patients' LOS by 10% and 5.6%, respectively, and improve the patients' and clinical personnel's satisfaction. Reducing the LOS not only leads to reduced OR costs but also helps increase the number of operations and, thereby, hospitals' revenue.


Download data is not yet available.


Sarvestani, N., Mohammadi, K. P., Kavoosi, Z., & Yousefi, A. (2015). The amount and causes insurance deductions of Shohada-e Sarvestan hospital and ways to reduce it by using the techniques of problem solving, 2012. J Manage Med Inform Sci, 2(2), 122-32.

Bhatt, A. S., Carlson, G. W., & Deckers, P. J. (2014). Improving operating room turnover time: a systems based approach. Journal of medical systems, 38, 1-8. https://doi.org/10.1007/s10916-014-0148-4

Denton, B., Viapiano, J., & Vogl, A. (2007). Optimization of surgery sequencing and scheduling decisions under uncertainty. Health care management science, 10, 13-24. https://doi.org/10.1007/s10729-006-9005-4

OECD (2024). Length of hospital stay (indicator). https://doi.org/10.1787/8dda6b7a-en

Mohammadkarim, B., Jamil, S., Pejman, H., Seyyed, M. H., & Mostafa, N. (2011). Combining multiple indicators to assess hospital performance in Iran using the Pabon Lasso Model. The Australasian medical journal, 4(4), 175. https://doi.org/10.4066/AMJ.2011.620

Arab, M. O. H. A. M. M. A. D., Zarei, A., Rahimi, A. B. A. S., Rezaiean, F., & Akbari, F. (2010). Analysis of factors affecting length of stay in public hospitals in Lorestan Province, Iran. Hakim Journal, 12(4), 27-32. [In Persian] https://magiran.com/p710277

van Poelgeest, R., van Groningen, J. T., Daniels, J. H., Roes, K. C., Wiggers, T., Wouters, M. W., & Schrijvers, G. (2017). Level of digitization in Dutch hospitals and the lengths of stay of patients with colorectal cancer. Journal of medical systems, 41, 1-7. https://doi.org/10.1007/s10916-017-0734-3

Kolker, A. (2008). Process modeling of emergency department patient flow: Effect of patient length of stay on ED diversion. Journal of Medical Systems, 32, 389-401. https://doi.org/10.1007/s10916-008-9144-x

Khosravizadeh, O., Vatankhah, S., Jahanpour, M., Yousefzadeh, N., Shahsavari, S., & Yari, S. (2020). Predicting Inpatient Length of Stay in Iranian Hospital: Conceptualization and Validation, The Asian Pacific Journal of Cancer Prevention (APJCP), 21(8), 2439-2446. https://doi.org/10.31557/APJCP.2020.21.8.2439

Achanta, A., Nordestgaard, A., Kongkaewpaisan, N., Han, K., Mendoza, A., Saillant, N., ... & Kaafarani, H. M. (2019). Most of the variation in length of stay in emergency general surgery is not related to clinical factors of patient care. Journal of Trauma and Acute Care Surgery, 87(2), 408-412. https://doi.org/10.1097/TA.0000000000002279

Gruskay, J. A., Fu, M. C., Bohl, D. D., Webb, M. L., & Grauer, J. N. (2013). Factors affecting length of stay following elective posterior lumbar spine surgery: a multivariate analysis, The Spine Journal, 15(6), 1188-1195. https://doi.org/10.1016/j.spinee.2013.10.022

Chuang, M. T., Hu, Y. H., & Lo, C. L. (2018). Predicting the prolonged length of stay of general surgery patients: a supervised learning approach. International Transactions in Operational Research, 25(1), 75-90. https://doi.org/10.1111/itor.12298

American Heritage (2007). The American heritage medical dictionary. Houghton Mifflin Harcourt. https://search.worldcat.org/title/71223299

Medical Dictionary for the Dental Professions. (2012). Farlex. https://medical-dictionary.thefreedictionary.com/

Tzeng, G. H., Teng, M. H., Chen, J. J., & Opricovic, S. (2002). Multicriteria selection for a restaurant location in Taipei. International journal of hospitality management, 21(2), 171-187. https://doi.org/10.1016/S0278-4319(02)00005-1

Shieh, J. I., Wu, H. H., & Huang, K. K. (2010). A DEMATEL method in identifying key success factors of hospital service quality. Knowledge-Based Systems, 23(3), 277-282. https://doi.org/10.1016/j.knosys.2010.01.013

Elahi, S. M., Hosseini, S. H., Dadras, M., & Zafari, N. (2014). Designing a strategic plan for manufacturing companies using important indicators of balanced scorecard performance and Dematel method, Industrial Management, 6(1), 1-22. [In Persian] https://doi.org/10.22059/IMJ.2014.52232

Asgharpour, M.G. (2010). Group Decision Making and Game Theory with the Perspective of Operations Research, Tehran University Publication. [In Persian]

Wu, W. W., & Lee, Y. T. (2007). Developing global managers’ competencies using the fuzzy DEMATEL method. Expert Systems With Applications, 32(2), 499-507. https://doi.org/10.1016/j.eswa.2005.12.005

Rabiee, S., & Shahandeh, A. (2011). An Expansion on the Balanced Scorecard Model, International Journal of Industrial Engineering and Production Management, 1 (22), 51-40. http://ijiepm.iust.ac.ir/article-1-594-en.html

Trevithick, S., Flabouris, A., Tall, G., & Webber, C. (2003) International EMS systems: New South Wales, Australia, Resuscitation, 59(2), 165-170. https://doi.org/10.1016/s0300-9572(03)00343-5

Tzeng, G. H., Chen, W. H., Yu, R., & Shih, M. L. (2010). Fuzzy decision maps: a generalization of the DEMATEL methods. Soft Computing, 14(11), 1141–1150. https://doi.org/10.1007/s00500-009-0507-0

Wu, G. (2018). Coordinated decision making on inter-organizational knowledge innovation of project-based supply chain. International Journal of Manufacturing Technology and Management, 32(2), 124-138. https://doi.org/10.1504/IJMTM.2018.090061

Yuan, X., Olfman, L., & Yi, J. (2020). How do institution-based trust and interpersonal trust affect interdepartmental knowledge sharing?. In Information Diffusion Management and Knowledge Sharing: Breakthroughs in Research and Practice (pp. 424-451). IGI Global. https://doi.org/10.4018/978-1-7998-0417-8.ch021

Ricci, W. M., Brandt, A., Mcandrew, C., & Gardner, M. J. (2015). Factors effecting delay to surgery and length of stay for hip fracture patients. Journal of orthopaedic trauma, 29(3), e109. https://doi.org/10.1097/BOT.0000000000000221

Sajadi, S. M., Ghasemi, S., & Vahdani, H. (2016). Simulation optimization for nurse scheduling in a hospital emergency department (case study: Shahid Beheshti Hospital). International Journal of Industrial and Systems Engineering, 23(4), 405-419. https://doi.org/10.1504/IJISE.2016.077691

Hadinezhad, P., Setareh, J., & Moosazadeh, M. (2019) Investigating the Factors Affecting the Length of Stay of Patients Admitted To Psychiatry Hospital in North of Iran, Iranian Journal of Health Sciences, 7(4), 19-25. https://doi.org/10.18502/jhs.v7i4.2204

Hosseini-Shokouh, S. M., Sadeghian, K., Ameryoun, A., & Zaboli, R. (2019). Organizational factors affecting a patient’s average length of stay in hospital: Systematic review. Journal of Military Medicine, 20(6), 577-588. https://militarymedj.bmsu.ac.ir/article_1000784.html?lang=en

Kim, S., & Kwon, M. (2020). Factors affecting the Post-Anesthetic Recovery Score and Length of Stay in the Recovery Room in Elderly Patients with Hypertension. Medico-Legal Update, 20(1). https://doi.org/10.37506/v20/i1/2020/mlu/194517

Göncü, K. K., & Çetin, O. (2022). A decision model for supplier selection criteria in healthcare enterprises with the Dematel ANP method. Sustainability, 14(21). 139-12. https://doi.org/10.3390/su142113912

Sharifian, R., Ghasemi, F., Kharazmi, E., Farhadi, P., Monem, H., & Shokrpour, N. (2023). An evaluation of the risk factors associated with implementing projects of health information technology by fuzzy combined ANP-DEMATEL. Plos One, 18(2), e0279819. https://doi.org/10.1371/journal.pone.0279819

Mamaghani, M. S., Ershadi, M. J., & Sajedinejad, A. (2023). A Business Intelligence Maturity Model in Healthcare Based on the Combination of Delphi and DEMATEL-ANP Methods. Business Intelligence Management Studies, 12(45), 117-156. [In Persian] https://doi.org/10.22054/ims.2023.70800.2250

Rostamzadeh, S., Abouhossein, A., Chalak, M. H., Vosoughi, S., & Norouzi, R. (2023). An integrated DEMATEL–ANP approach for identification and prioritization of factors affecting fall from height accidents in the construction industry, International Journal of Occupational Safety and Ergonomics, 29(2), 474-483. https://doi.org/10.1080/10803548.2022.2052479

Ghaderi, M., Jahantigh, F. F., Koushan, M., & Wood, L. C. (2023). Positioning of aerial ambulances to improve health care access: A framework using fuzzy DEMATEL and fuzzy ANP. International Journal of Healthcare Management, 1-12. https://doi.org/10.1080/20479700.2023.2190070

Bashkin, O., Caspi, S., Haligoa, R., Mizrahi, S., & Stalnikowicz, R. (2015). Organizational Factors affecting length of stay in the emergency department: initial observational study. Israel Journal of Health Policy Research, 4, 1-7. https://doi.org/10.1186/s13584-015-0035-6

Dodek, P. M., Norena, M., Wong, H., Keenan, S., & Martin, C. (2015). Assessing the influence of intensive care unit organizational factors on outcomes in Canada: is there residual confounding? Journal of Intensive Care Medicine, 30(7), 413-419. https://doi.org/10.1177/0885066614521973

Yaghoubi, M., Karimi, S., Ketabi, S., & Javadi, M. (2011). Factors affecting patients' length of stay in Alzahra hospital based on hierarchical analysis technique. Health Information Management, 8(3), 326-34. [In Persian] https://him.mui.ac.ir/article_11082.html

Ido, M. S., Okosun, I. S., Bayakly, R., Clarkson, L., Lugtu, J., & Floyd, S. (2016). Door to intravenous tissue plasminogen activator time and hospital length of stay in acute ischemic stroke patients, Georgia, 2007-2013, Journal Stroke Cerebrovasc Disease, 25(4), 866-871. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.12.025

Kossovsky, M. P., Sarasin, F. P., Chopard, P., LouisSimonet, M., Sigaud, P., & Perneger, T. V. (2002). Relationship between hospital length of stay and quality of care in patients with congestive heart failure. BMJ Quality & Safety, 11(3), 219-223. https://doi.org/10.1136/qhc.11.3.219

McMullan, R., Silke, B., Bennett, K., & Callachand, S. (2004). Resource utilization, length of hospital stay, and pattern of investigation during acute medical hospital admission. Postgraduate Medical Journal, 80(939), 23-26. https://doi.org/10.1136/pmj.2003.007500

Borghans, I., Heijink, R., Kool, T., Lagoe, R. J., & Westert, G. P. (2008). Benchmarking and reducing length of stay in Dutch hospitals. BMC health services research, 8, 1-9. https://doi.org/10.1186/1472-6963-8-220

Nasiripour, A. A., Riyahi, L. E. I. L. A., & Gholamipour, M. A. (2010). The effect of the presence of full time gynecologist on length of stay among inpatient of gynecology ward in yazd social security hospital, 2008. Journal of Medical Council of Islamic Republic of Iran, 28(2), 169-235. [In Persian]

Gohari, M., Vahabi, N., & Moghadamifard, Z. (2012). Semi-parametric Cox regression for factors affecting hospitalization length. Daneshvar Medicine, 20(2), 23-30. [In Persian]

Nikookar, R., Ghaffari, S., Kamrani, A. A., Sahaf, R., Moghadam, M., & Ghadimi, M. R. (2015). Review of unnecessary length of stay and costs of elderly patients with stroke in acute care department of Fayyaze Bakhsh hospital-Tehran. Iranian Journal of Ageing, 10(2), 180-187. [In Persian]

Arab, M. O. H. A. M. M. A. D., Zarei, A., Rahimi, A. B. A. S., Rezaiean, F., & Akbari, F. (2010). Analysis of factors affecting length of stay in public hospitals in Lorestan Province, Iran. Hakim Journal, 12(4), 27-32 [In Persian]

Karim, H., Tara, S. M., & Etminani, K. (2015). Factors associated with length of hospital stay: a systematic review. Journal of Health and Biomedical Informatics, 1(2), 131-142. [In Persian]

Kohlnhofer, B. M., Tevis, S. E., Weber, S. M., & Kennedy, G. D. (2014). Multiple complications and short length of stay are associated with postoperative readmissions. The American Journal of Surgery, 207(4), 449-456. https://doi.org/10.1016/j.amjsurg.2013.10.022

Helman, S. N., Brant, J. A., Moubayed, S. P., Newman, J. G., Cannady, S. B., & Chai, R. L. (2017). Predictors of length of stay, reoperation, and readmission following total laryngectomy. The Laryngoscope, 127(6), 1339-1344. https://doi.org/10.1002/lary.26454

Wu, A., Sanford, J. A., Tsai, M. H., O’Donnell, S. E., Tran, B. K., & Urman, R. D. (2017). Analysis to establish differences in efficiency metrics between operating room and non-operating room anesthesia cases. Journal of Medical Systems, 41, 1-6. https://doi.org/10.1007/s10916-017-0765-9



How to Cite

Mousavi, S. R., Sepehri, M., & Najafi, S. E. (2024). A Framework for Improving Patient Satisfaction by Reducing the Length of Stay in The Operation Suite Using the Combined DEMATEL-ANP Model. Decision Making: Applications in Management and Engineering, 7(2), 197–220. https://doi.org/10.31181/dmame722024882