# Developing a Decision-Making Framework to Improve Healthcare Service Quality during a Pandemic
## 5 Discussion
### Implications of This Study  
Natural and man-made disasters cause many acute disruptions to the healthcare sector, but it is likely that the COVID-19 pandemic will have a longer-lasting effect. After estimating the impacts of COVID-19, researchers have turned their attention to exploring new possible strategies for mitigating the pandemic-related issues. One of the main objectives of this study is to consider the issues related to the hospital's strategic, tactical, and operational levels so that appropriate strategies can be developed to improve the service quality of the patients. This paper presents a framework that allows managers to identify optimal courses of action in real-time that will improve quality of service in the healthcare sector during the present COVID-19 pandemic. This study examined two hypothetical scenarios dealing with service quality improvements in the healthcare sector during the COVID-19 pandemic.  
\begin{table}
\begin{tabular}{c c c c c c} \hline \hline  & **Scenario 1** & \multicolumn{4}{c}{**Scenario 2**} \\ \hline
**BWM-MAMCA** & **MOLP** & \multicolumn{2}{c}{**BWM–MAMCA**} & **MOLP** \\ \hline Stakeholder & Rank & Rank & Stakeholder & Rank & Rank \\ \hline STKH 1 & A4 & A1 & STKH 1 & A1 & A1 \\ \hline STKH 2 & A3 & A4 & STKH 2 & A3 & A3 \\ \hline STKH 3 & A1 & A3 & STKH 3 & A1 & A4 \\ \hline STKH 4 & A3 & A2 & STKH 4 & A4 & A5 \\ \hline STKH 5 & A1 and A2 & A5 & STKH 5 & A1 & A2 \\ \hline \hline \end{tabular}
\end{table}
Table 8: Comparison of Scenario 1 and Scenario 2 results.  
The identified criteria will help decision makers to proactively select the right initiatives or strategies to increase not only patient service quality but also proper use of resources and minimization of financial loss. The results of the two hypothetical scenarios indicate that hiring part-time physicians and medical staff is the most favorable solution for improving service quality in the ICU during the pandemic.  
During this pandemic, governmental policies, medical standards, working hours, precautionary measures, and treatment methods have all frequently changed with little to no notice. The dynamic nature of this situation requires decisions to be made quickly and efficiently, as doing so will provide the greatest benefits for patients and healthcare professionals. The proposed integrated framework is an excellent tool that can provide sustainable solutions quickly. Although an ICU was selected due to the level of complexity, participation of multiple stakeholders, and need for quick and sustainable decisions, the developed framework can be implemented in any hospital department within the context. Managers who wish to implement this decision-making tool in real-time should consider the following suggestions. First, in order to reach a sustainable solution in any case, the managers must select appropriate criteria, alternatives, and stakeholders [2]. Second, more highly refined results can be achieved by including multiple participants in each stakeholder group. Third, managers should pay more attention to the stakeholders' selection of criteria, as it directly influences the ranking of alternatives. Finally, since the framework default provides a consensus solution, the managers will not need to engage in rounds of negotiation with the stakeholders. This could prove very helpful within a pandemic context, as it facilitates the selection of sustainable solutions in short periods of time.