Development of a sustainable healthcare waste management model using hybrid multiple decision making model

Healthcare waste treatment (HCWT) has become one of the most significant concerns in the world, especially in developing countries. Between 10–25% of healthcare waste is regarded as infectious and hazardous that may pose the health hazard to staffs and patients as well as environmental pollutions. Therefore, safe and reliable methods for handling healthcare waste are essential. Inadequate and inappropriate management of healthcare waste may have serious public health consequences and a significant impact on the environment. Since in Malaysia the quantity of clinical waste disposed at incinerators in 2013 increase by 17.5% as compared to 2009, the selection of appropriate healthcare waste treatment and disposal technologies for the safe and secure management of healthcare waste (HCW) is significantly important to avoid human health and environmental issues. Thus, this dissertation aims at developing a multi-criteria decision-making (MCDM) model for healthcare waste treatment and selection in healthcare industries as well as providing a list of applicable criteria and sub-criteria for effectiveness alternative healthcare waste treatment. This study proposed a model to facilitate the decisionmaking process and help managers of healthcare centres in decision-making. There are four technologies of healthcare waste treatment such as incineration, autoclaving, microwaving, landfilling, and plasma pyrolysis technologies. For selecting treatment technologies for HCWs, decision-makers have to take into account various important criteria simultaneously for successful outcomes and optimal decisions. The sustainability is a natural subject of MCDM includes four subsets of criteria: economics, environmental, technical and social aspects. Therefore, the evaluation of HCW treatment technologies, as a complex MCDM problem, needs to trade-off multiple conflicting criteria with the involvement of a group of healthcare waste management experts. A set consisting of 4 main criteria and 17 sub-criteria were identified as sub-criteria that affect in selecting the effective healthcare waste treatment method. When a decision is made, there is a need to look at all of the potential relationships/dependencies among the criteria. Also, the correlation between the aspiration-level factors and the alternatives of a system are necessary to be shown that are closest to the ideals solution based on the weights of each factor. To respect to these issues, a hybrid MCDM model combining DEMATEL, ANP, VIKOR and GRA methods applied. At first, a model of a set consisting of main criteria was developed, using experts’ opinions. Then DEMATEL analysis carried out to develop a cause and effect model and identify those that need to be improved first. Based on the result, the economic criterion has the highest effect, followed by technical and social and environmental criteria have the lowest effect. The DANP used to identify important criteria for selection of sustainable healthcare waste (SHCW) technology in Malaysia based on the interrelationships that release with health effects, community and staff acceptance and land requirement identified as three top most important criteria. After that, VIKOR with influential weights (DANP) applied to rank and develop a sustainable healthcare waste treatment (SHCWT) model. The ranking order of the alternative treatments were non-incineration respectively steam sterilization, plasma pyrolysis and microwave on the basis of the technical, economic, social and environmental aspects and their related criteria. Hence it arrives at a decision for the final technology selection based on the principles of sustainability. For verifying this method, the ranking result compared with another MCDM method involving GRA. It observed that the top-ranked alternatives match those derived by both of them as well as previous studies.

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