Concurrent Optimization of Patients’ Trust and Integrated Resilience Engineering: A Z-Number Data Envelopment Analysis Approach

Background and Objectives: Emergency departments (EDs) often encounter several risk and health issues which significantly impact on overall healthcare performance. Resilience engineering (RE) enables EDs to confront sudden changes and handling health risk issues. Patient trust (PT) is also one of the most effective factors which improve quality of care along with patient satisfaction. Methods: This study integrates RE and trust to enhance the overall performance of EDs. A unique algorithm is introduced to demonstrate the superiority of the proposed integrated approach. It is composed of Z-number data envelopment analysis (DEA), fuzzy DEA, and statistical analysis. The required data are collected using standard questionnaires from a real-life ED. The obtained results are verified and validated by FDEA. Findings: The results indicate that considering RE and trust increases ED efficiency significantly. Also, flexibility, fault-tolerance, reporting culture, and specialty level are the most effective factors. Moreover, trust and resiliency have similar statistical impacts on overall system efficiency. Conclusions: One of the concerns of medical service providers nowadays is to build an efficient ED capable of providing services to a large number of patients. Therefore, to evaluate the performance of the ED, both concepts of PT and RE which are applicable to enhance the preventive safety and promote the performance, are simultaneously considered for the first time in this study.