# Developing a Decision-Making Framework to Improve Healthcare Service Quality during a Pandemic
## 1 Introduction  
Healthcare is a complex service sector that requires the involvement of multiple stakeholders with different preferences and values in the decision-making process [1]. For the past three decades, researchers have solved real-time problems in healthcare settings using a different multi-criteria decision making (MCDM) methods including Analytic Hierarchy Method (AHP) and hybrid methods [1, 2]. The MCDM method has become widely used due to its use of quantitative and qualitative data, as this allows researchers to reach trustworthy, consensus decisions in situations with contradicting evidence. [PERSON] et al. [2] suggested the use of MCDM tools for different areas in healthcare service improvement. Although the inclusion of multiple stakeholders in the decision-making process is critical for yielding more sustainable solutions, it can make it much more difficult to achieve consensus, as each stakeholder may have their own preferences and values. As such, each stakeholder may be more focused on their own objectives rather than finding the best solution for the organization overall. For example, in the healthcare sector, physicians aim to improve their equipment resources, but the administrative staff may be focused on improving the quality of service received by patients; this divergence in viewpoints thus makes it difficult to reach a consensus solution. Fortunately, the application of a hybrid decision-making framework can help stakeholders overcome these conflicting aims and find a consensus solution. The need for MCDM in healthcare has peaked during the current Novel Coronavirus (COVID-19) pandemic, as it has required governments to make frequent real-time changes to health policies and priorities in response to this rapidly developing situation. Given the complexities that arise from having to include multiple stakeholders in the decision-making process, the real challenge for hospital management is selecting an appropriate decision-making tool. Although different group decision-making tools are available, achieving consensus among a diverse group of stakeholders in a short period will always be difficult. The pandemic has caused the whole healthcare system to become congested, but this problem has become especially critical for Intensive Care Units (ICU), which have become severely congested due to limited capacity and increased demand [3; 4]. While the MCDM framework developed in this paper is general in nature, we apply it to an ICU ward, as it treats high-priority patients who require the highest quality of service at all times [4]. Another reason for considering an ICU ward is that the medical staff and physicians have a relatively higher chance of making errors due to work fatigue [5; 6]. Our work aims to answer the following research questions:  
1. What are the important criteria involved to enhance service quality in the ICU during this pandemic? 2. What are the effective solutions that can be applied to improve the quality of service received by ICU patients during this pandemic? 3. How can multiple stakeholders and their preferences be included in the decision-making process? In order to answer these questions, this study proposes a collaborative multi-stakeholder decision-making framework that, when implemented, can improve the quality of service received by patients during this pandemic. The majority of previous studies like this one have focused on finding the best solutions by combining different MCDM methods [7; 8]. Most existing MCDM methods provide results based on a single stakeholder group opinion. However, including stakeholders in the decision-making process is a critical task for the health care sector, even though their various preferences can make it difficult to achieve a consensus solution. Indeed, lack of consensus among stakeholders causes many solutions obtained through the collective decision-making process to ultimately become unsustainable [9].