Abstract
Sustainability and performance assessment are significant aspects for organizations such as healthcare systems in order to make sustainable decisions and to improve the quality. A sustainability framework usually addresses economic, social and environmental impacts. In many real applications, uncertainty and imprecise data are also perceived. Therefore, the current study proposes a novel approach based on data envelopment analysis (DEA) to examine the sustainability performance of systems in the presence of imprecise measures. To illustrate, the performance of systems with fuzzy data from each perspective, economic, social and environmental, is evaluated while weakly disposable undesirable outputs are presented. For this purpose, the constant and variable returns to scale fuzzy non-radial approaches with undesirable outputs are introduced. Fuzzy scale efficiency scores and the returns to scale status are also appraised for each sustainability dimension. Then, the overall sustainability performance is estimated using an alternative fuzzy composite indicators aggregate approach based on DEA. Our proposed approach is applied to measure the sustainability performance of hospitals. The findings disclose informative details about overall sustainability performance in hospitals and also strengths and weaknesses in each dimension.





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Agarwal S (2017) Scale efficiency with fuzzy data. Int J Bus Syst Res 11:152–162
Ali M, Wang W, Chaudhry N, Geng Y, Ashraf U (2017) Assessing knowledge, performance, and efficiency for hospital waste management—a comparison of government and private hospitals in Pakistan. Environ Monit Assess 189:181. https://doi.org/10.1007/s10661-017-5903-9
Amirteimoori H, Amirteimoori A, Amirteimoori A (2020) Sustainability assessment in the presence of undesirable factors over time: A case on gas companies. Expert Syst 37:e12316. https://doi.org/10.1111/exsy.12316
Andria J, di Tollo G, Pesenti R (2020) A heuristic fuzzy algorithm for assessing and managing tourism sustainability. Soft Comput 24:4027–4040. https://doi.org/10.1007/s00500-019-04170-5
Arya A, Yadav SP (2017) A Fuzzy Dual SBM Model with Fuzzy Weights: An Application to the Health Sector. In: Proceedings of Sixth International Conference on Soft Computing for Problem Solving. Springer Singapore, pp 230–238
Arya A, Yadav SP (2019) Development of intuitionistic fuzzy data envelopment analysis models and intuitionistic fuzzy input–output targets. Soft Comput 23:8975–8993. https://doi.org/10.1007/s00500-018-3504-3
Avkiran NK (2001) Investigating technical and scale efficiencies of Australian Universities through data envelopment analysis. Socio-Econ Plan Sci 35:57–80. https://doi.org/10.1016/S0038-0121(00)00010-0
Azapagic A, Perdan S (2000) Indicators of sustainable development for industry: a general framework. Process Saf Environ 78:243–261. https://doi.org/10.1205/095758200530763
Baoding L, Yian-Kui L (2002) Expected value of fuzzy variable and fuzzy expected value models. IEEE Trans Fuzzy Syst 10:445–450. https://doi.org/10.1109/TFUZZ.2002.800692
Behera N, Tripathy P (2016) Fuzzy EOQ model for time deteriorating items using penalty cost. Am J Oper Res 6:1–8
Boussemart J-P, Leleu H, Shen Z, Valdmanis V (2020) Performance analysis for three pillars of sustainability. J Product Anal 53:305–320. https://doi.org/10.1007/s11123-020-00575-9
Carnero MC (2015) Assessment of environmental sustainability in health care organizations. Sustainability 7:8270–8291
Charnes A, Cooper WW, Rhodes E (1978) Measuring the efficiency of decision making units. Eur J Oper Res 2:429–444. https://doi.org/10.1016/0377-2217(78)90138-8
Coelli T, Rao DSP, Battese GE (1998) Efficiency measurement using data envelopment analysis (DEA). In: An introduction to efficiency and productivity analysis. Springer US, Boston, MA, pp 133–160. doi:https://doi.org/10.1007/978-1-4615-5493-6_6
Dotoli M, Epicoco N, Falagario M, Sciancalepore F (2015) A cross-efficiency fuzzy data envelopment analysis technique for performance evaluation of decision making units under uncertainty. Comput Ind Eng 79:103–114. https://doi.org/10.1016/j.cie.2014.10.026
Emrouznejad A, Tavana M (2014) Performance Measurement with Fuzzy Data Envelopment Analysis In the series of “Studies in Fuzziness and Soft Computing”, Springer-Verlag, ISBN 978-3-642-41371-1
Färe R, Grosskopf S (2003) Nonparametric productivity analysis with undesirable outputs: comment. Am J Agric Eco 85:1070–1074
Färe R, Grosskopf S (2009) A comment on weak disposability in nonparametric production analysis. Am J Agric Eco 91:535–538
Färe R, Grosskopf S, Lovell CAK, Pasurka C (1989) Multilateral productivity comparisons when some outputs are undesirable: a nonparametric approach. Rev Econ Stat 71:90–98. https://doi.org/10.2307/1928055
Galán-Martín Á, Guillén-Gosálbez G, Stamford L, Azapagic A (2016) Enhanced data envelopment analysis for sustainability assessment: a novel methodology and application to electricity technologies. Comput Chem Eng 90:188–200. https://doi.org/10.1016/j.compchemeng.2016.04.022
Goh CY, Marimuthu M (2016) The path towards healthcare sustainability: the role of organisational commitment. Procedia Soc Behav Sci 224:587–592. https://doi.org/10.1016/j.sbspro.2016.05.445
Gong Y, Liu J, Zhu J (2019) When to increase firms’ sustainable operations for efficiency? A data envelopment analysis in the retailing industry. Eur J Oper Res 277:1010–1026. https://doi.org/10.1016/j.ejor.2019.03.019
Gupta P, Mehlawat MK, Inuiguchi M, Chandra S (2014) Fuzzy portfolio optimization: advances in hybrid multi-criteria methodologies. Springer
Hadi-Vencheh A (2014) Two effective total ranking models for preference voting and aggregation. Math Sci 8:115. https://doi.org/10.1007/s40096-014-0115-8
Hadi-Vencheh A, Wanke P, Jamshidi A, Chen Z (2020) Sustainability of Chinese airlines: a modified slack-based measure model for CO2 emissions. Expert Syst 37:e12302. https://doi.org/10.1111/exsy.12302
Hailu A, Veeman TS (2001) Non-parametric productivity analysis with undesirable outputs: an application to the canadian pulp and paper industry. Am J Agric Eco 83:605–616
Halkos G, Petrou KN (2019) Treating undesirable outputs in DEA: A critical review. Econ Anal Policy 62:97–104. https://doi.org/10.1016/j.eap.2019.01.005
Halos GE, Tzeremes NG, Kourtzidis SA (2016) Measuring sustainability, efficiency using a two-stage data envelopment analysis approach. J Ind Ecol 20:1159–1175. https://doi.org/10.1111/jiec.12335
Hatami-Marbini A, Emrouznejad A, Tavana M (2011) A taxonomy and review of the fuzzy data envelopment analysis literature: two decades in the making. Eur J Oper Res 214:457–472. https://doi.org/10.1016/j.ejor.2011.02.001
Hatami-Marbini A, Ebrahimnejad A, Lozano S (2017) Fuzzy efficiency measures in data envelopment analysis using lexicographic multiobjective approach. Comput Ind Eng 105:362–376. https://doi.org/10.1016/j.cie.2017.01.009
Hatefi SM, Haeri A (2019) Evaluating hospital performance using an integrated balanced scorecard and fuzzy data envelopment analysis. J Health Manag Inform 6:66–76
Hoang V-N, Alauddin M (2012) Input-orientated data envelopment analysis framework for measuring and decomposing economic, environmental and ecological efficiency: an application to OECD agriculture. Environ Resour Econ 51:431–452. https://doi.org/10.1007/s10640-011-9506-6
Hussain M, Ajmal MM, Gunasekaran A, Khan M (2018) Exploration of social sustainability in healthcare supply chain. J Clean Prod 203:977–989. https://doi.org/10.1016/j.jclepro.2018.08.157
Izadikhah M, Saen RF (2018) Assessing sustainability of supply chains by chance-constrained two-stage DEA model in the presence of undesirable factors. Comput Oper Res 100:343–367. https://doi.org/10.1016/j.cor.2017.10.002
Jahani Sayyad Noveiri M, Kordrostami S (2020) Trade-offs analysis of sustainability dimensions using integer-valued data envelopment analysis. Croat Oper Res Rev 11:275–289
Jahani Sayyad Noveiri M, Kordrostami S, Wu J, Amirteimoori A (2019) Supply chains performance with undesirable factors and reverse flows: a DEA-based approach. J Oper Res Soc 70:125–135. https://doi.org/10.1080/01605682.2017.1421852
Jiang B, Li Y, Lio W, Li J (2020) Sustainability efficiency evaluation of seaports in China: an uncertain data envelopment analysis approach. Soft Comput 24:2503–2514. https://doi.org/10.1007/s00500-018-3559-1
Kalantary M, Farzipoor Saen R (2019) Assessing sustainability of supply chains: an inverse network dynamic DEA model. Comput Ind Eng 135:1224–1238. https://doi.org/10.1016/j.cie.2018.11.009
Khodakarami M, Shabani A, Farzipoor Saen R (2014) A new look at measuring sustainability of industrial parks: a two-stage data envelopment analysis approach. Clean Technol Environ Policy 16:1577–1596. https://doi.org/10.1007/s10098-014-0733-8
Khoshandam L, Kazemi Matin R, Amirteimoori A (2015) Marginal rates of substitution in data envelopment analysis with undesirable outputs: a directional approach. Measurement 68:49–57. https://doi.org/10.1016/j.measurement.2015.02.020
Kohl S, Schoenfelder J, Fügener A, Brunner JO (2019) The use of data envelopment analysis (DEA) in healthcare with a focus on hospitals. Health Care Manag Sci 22:245–286. https://doi.org/10.1007/s10729-018-9436-8
Koopmans T (1951) Analysis of production as an efficient combination of activities. In: Activity Analysis of Production and Allocation John Wiley and Sons, New York, 33-97
Korhonen PJ, Luptacik M (2004) Eco-efficiency analysis of power plants: an extension of data envelopment analysis. Eur J Oper Res 154:437–446. https://doi.org/10.1016/S0377-2217(03)00180-2
Kuosmanen T (2005) Weak disposability in nonparametric production analysis with undesirable outputs. Am J Agric Eco 87:1077–1082
Kuosmanen T, Podinovski V (2009) Weak disposability in nonparametric production analysis: reply to färe and grosskopf. Am J Agric Eco 91:539–545. https://doi.org/10.1111/j.1467-8276.2008.01238.x
Lertworasirikul S, Fang S-C, Nuttle HLW, Joines JA (2003) Fuzzy BCC model for data envelopment analysis. Fuzzy Optim Decis Mak 2:337–358. https://doi.org/10.1023/B:FODM.0000003953.39947.b4
Lombardi GV et al (2019) The sustainability of the Italian water sector: an empirical analysis by DEA. J Clean Prod 227:1035–1043. https://doi.org/10.1016/j.jclepro.2019.04.283
Lu M-T, Tsai J-F, Shen S-P, Lin M-H, Hu Y-C (2020) Estimating sustainable development performance in the electrical wire and cable industry: applying the integrated fuzzy MADM approach. J Clean Prod 277:122440. https://doi.org/10.1016/j.jclepro.2020.122440
Maghbouli M, Amirteimoori A, Kordrostami S (2014) Two-stage network structures with undesirable outputs: a DEA based approach. Measurement 48:109–118. https://doi.org/10.1016/j.measurement.2013.10.032
McGain F, Naylor C (2014) Environmental sustainability in hospitals – a systematic review and research agenda. J Health Serv Res Pol 19:245–252. https://doi.org/10.1177/1355819614534836
Mehdiloo M, Podinovski VV (2019) Selective strong and weak disposability in efficiency analysis. Eur J Oper Res 276:1154–1169. https://doi.org/10.1016/j.ejor.2019.01.064
Nicolăescu E, Alpopi C, Zaharia C (2015) Measuring corporate sustainability performance. Sustainability 7:851–865
Otay İ, Oztaysi B, Cevik Onar S, Kahraman C (2017) Multi-expert performance evaluation of healthcare institutions using an integrated intuitionistic fuzzy AHP&DEA methodology. Knowl Based Syst 133:90–106. https://doi.org/10.1016/j.knosys.2017.06.028
Pope J, Annandale D, Morrison-Saunders A (2004) Conceptualising sustainability assessment. Environ Impact Assess Rev 24:595–616. https://doi.org/10.1016/j.eiar.2004.03.001
Rashidi K, Cullinane K (2019) Evaluating the sustainability of national logistics performance using data envelopment analysis. Transp Policy 74:35–46. https://doi.org/10.1016/j.tranpol.2018.11.014
Rodrigues WS, Mauad JRC, Vogel E, Sabbag OJ, Ruviaro CF (2019) Sustainability and technical efficiency of fish hatcheries in the STATE of MATO GROSSO do SUL, Brazil. Aquaculture 500:228–236. https://doi.org/10.1016/j.aquaculture.2018.10.024
Rosano-Peña C, Guarnieri P, Sobreiro VA, Serrano ALM, Kimura H (2014) A measure of sustainability of Brazilian agribusiness using directional distance functions and data envelopment analysis. Int J Sust Dev World 21:210–222. https://doi.org/10.1080/13504509.2014.901992
Sarkhosh-Sara A, Tavassoli M, Heshmati A (2019) Assessing the sustainability of high-, middle-, and low-income countries: A network DEA model in the presence of both zero data and undesirable outputs. Sustain Prod Consum. https://doi.org/10.1016/j.spc.2019.08.009
Sarkis J (2016) Corporate Environmental Sustainability and DEA. In: Hwang S-N, Lee H-S, Zhu J (eds) Handbook of Operations Analytics Using Data Envelopment Analysis. Springer, US, Boston, pp 483–498
Sengupta JK (1992a) A fuzzy systems approach in data envelopment analysis. Comput Math Appl 24:259–266. https://doi.org/10.1016/0898-1221(92)90203-T
Sengupta JK (1992b) Measuring efficiency by a fuzzy statistical approach. Fuzzy Sets Syst 46:73–80. https://doi.org/10.1016/0165-0114(92)90268-9
Sotoudeh-Anvari A, Najafi E, Sadi-Nezhad S (2016) A new data envelopment analysis in fully fuzzy environment on the base of the degree of certainty of information. J Intell Fuzzy Syst 30:3131–3142. https://doi.org/10.3233/IFS-152039
Struve B, Anke TC, Klumpp M (2019) DEA sustainability evaluation in automotive supply Chains. In: Bierwirth C, Kirschstein T, Sackmann D (eds) Logistics management. Springer International Publishing, Cham, pp 203–220
Tajbakhsh A, Shamsi A (2019) Sustainability performance of countries matters: a non-parametric index. J Clean Prod 224:506–522. https://doi.org/10.1016/j.jclepro.2019.03.189
Tavassoli M, Saen RF, Zanjirani DM (2020) Assessing sustainability of suppliers: a novel stochastic-fuzzy DEA model. Sustain Prod Consum 21:78–91. https://doi.org/10.1016/j.spc.2019.11.001
Thies C, Kieckhäfer K, Spengler TS, Sodhi MS (2019) Operations research for sustainability assessment of products: a review. Eur J Oper Res 274:1–21. https://doi.org/10.1016/j.ejor.2018.04.039
Tian N, Tang S, Che A, Wu P (2020) Measuring regional transport sustainability using super-efficiency SBM-DEA with weighting preference. J Clean Prod 242:118474. https://doi.org/10.1016/j.jclepro.2019.118474
Tsaples G, Papathanasiou J, Georgiou AC, Samaras N (2019) Assessing multidimensional sustainability of European Countries with a Novel, Two-Stage DEA. In: Freitas PSA, Dargam F, Moreno JM (eds) Decision Support Systems IX: Main developments and future trends. Springer International Publishing, Cham, pp 111–122
Wang X, Lai W, Song X, Lu C (2018) Implementation efficiency of corporate social responsibility in the construction industry: a China study. Int J Environ Res Public Health 15:2008
Wong K, Chong K, Chew B, Tay C, Mohamed S (2018) Key performance indicators for measuring sustainability in health care industry in Malaysia. J Fundam Appl Sci 10:646–657
Yang G-l, Fukuyama H, Chen K (2019) Investigating the regional sustainable performance of the Chinese real estate industry: a slack-based DEA approach. Omega 84:141–159. https://doi.org/10.1016/j.omega.2018.04.009
Yousefi S, Soltani R, Bonyadi Naeini A, Farzipoor Saen R (2019) A robust hybrid artificial neural network double frontier data envelopment analysis approach for assessing sustainability of power plants under uncertainty. Expert Syst 36:e12435. https://doi.org/10.1111/exsy.12435
Zadeh LA (1965) Fuzzy sets. Inf. Control 8:338–353. https://doi.org/10.1016/S0019-9958(65)90241-X
Zadeh LA (1975) The concept of a linguistic variable and its application to approximate reasoning—I. Inf Sci 8:199–249. https://doi.org/10.1016/0020-0255(75)90036-5
Zadeh LA (1983) Linguistic variables, approximate reasoning and dispositions. Med Inform 8:173–186. https://doi.org/10.3109/14639238309016081
Zare H, Tavana M, Mardani A, Masoudian S, Kamali Saraji M (2019) A hybrid data envelopment analysis and game theory model for performance measurement in healthcare. Health Care Manag Sci 22:475–488. https://doi.org/10.1007/s10729-018-9456-4
Zhao L, Zha Y, Zhuang Y, Liang L (2019) Data envelopment analysis for sustainability evaluation in China: tackling the economic, environmental, and social dimensions. Eur J Oper Res 275:1083–1095. https://doi.org/10.1016/j.ejor.2018.12.004
Zhou P, Ang B (2008) Indicators for assessing sustainability performance. In: Misra KB (ed) Handbook of performability engineering. Springer, pp 905–918
Zhou X, Pedrycz W, Kuang Y, Zhang Z (2016) Type-2 fuzzy multi-objective DEA model: an application to sustainable supplier evaluation. Appl Soft Comput 46:424–440. https://doi.org/10.1016/j.asoc.2016.04.038
Zhou H, Yang Y, Chen Y, Zhu J (2018) Data envelopment analysis application in sustainability: the origins, development and future directions. Eur J Oper Res 264:1–16. https://doi.org/10.1016/j.ejor.2017.06.023
Zimmermann H-J (2011) Fuzzy set theory—and its applications. Springer Science & Business Media
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Jahani Sayyad Noveiri, M., Kordrostami, S. Sustainability assessment using a fuzzy DEA aggregation approach: a healthcare application. Soft Comput 25, 10829–10849 (2021). https://doi.org/10.1007/s00500-021-05992-y
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DOI: https://doi.org/10.1007/s00500-021-05992-y