Strategic SWOT Analysis for Use of IT by Rural Physicians by Fuzzy ANP Method

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1 Strategic SWOT Analysis for Use of IT by Rural Physicians by Fuzzy ANP Method Hamidreza Feili * 1, Ramin Baloochnejad 2, Alireza Foghani 3, Ramin Arghandeh 4 1 Assistant Professor, Department of Industrial Engineering, Faculty of Engineering, Islamic Azad University, Karaj branch, Karaj, Iran. 2,3,4 Department of Industrial Engineering, Faculty of Engineering, Karaj branch, Islamic Azad University, Karaj, Iran. ABSTRACT This paper studies the opportunities for deploying IT in rural medical centers and uses SWOT matrix to identify influencing factors on the plan or organization. Strategies are formulated based on internal and external factors of SWOT matrix. Next, strategies are ranked which is not possible by SWOT matrix alone and the matrix solely defines the effect of influencing factors on organization and then strategies. Fuzzy ANP method is used to prioritize strategies so that strategies for deployment of IT in rural medical centers would be prioritized properly. INTRODUCTION Nowadays, we are seeing immigration of villagers to urban areas. This immigration could have several reasons, such as low medical, educational and welfare service rate or shortage or lack of basic products or shortage of job opportunities in villages. %30 of Iran population are villagers thus, this issue requires more attention to be solved. In case of provision of medical, educational, cultural, economic services to villagers, the need to migrate to cities would be minimized [1]. Iran has kicked off the plan to equip villages to ICT offices in order to provide access to communication services for villagers and few thousand villages are equipped up to now [2]. These offices are opened by support from government and private sector. Therefore, leveraging these offices and the possibility of access to internet for paramedics and physicians can help them in their services to villagers and reduce the dependency of villagers on urban medical services. Provided the medical needs of villagers are properly met, road traffic would be reduced and ultimately road accidents would decrease. Thus, this paper seeks the role of IT in rural medical service. Importance of IT in sustainable rural development: access to information and communication technologies is necessary for rural communities in 21st century. It has to be noted that IT brings challenges for sustainable development plan for developing countries, as well as opportunities [3]. It is believed that information and communications can lead to more awareness for identification of issues and implementation of proper resolutions and improvement of collective commitment. Therefore, in addition to awareness, IT can improve solidarity and communication of local communities towards engagement of villagers and their participation in inter-village efforts and interaction with development agents [2, 4]. IT potentials and capabilities for rural sustainable development: The reason for acceptability of IT in rural areas is based on positive effects brought by these technologies. Some of the most important ICT potentials and capabilities for rural sustainable development are mentioned below [5]: - Reduction in immigration rate to cities for medical reasons - Increase in information exchange among physicians - Possibility of more effective communication among physicians - Better medical informing in villages 116

2 - Less distance between cities and villages - Less traffic for cities - Less pollution in metropolises - Creation of job opportunities in villages - Less road accident - More dynamism in agricultural development Research background SWOT is a major tool for decision making. This matrix is used for strategic planning. Influencing factors on organization (internal and external) are grouped into four categories of strengths, weaknesses, opportunities and threats. and weaknesses refer to inside of an organization and opportunities and threats refer to outside realm of the organization and the organization has no control over them. Upon prioritization and ranking of these factors, organization strategies are defined. The idea behind this matrix is to eliminate weaknesses by strengths and using external opportunities or leveraging them to confront threats. Matrix strategies are SO (aggressive tactics toward opportunities based on strengths), ST (deploying strengths to prevent or reduce external threats), WO (improving internal weaknesses by leveraging external opportunities) and WT (defensive tactics to reduce internal weaknesses and avoiding threats). SWOT matrix is not able to prioritize these strategies in terms of their importance. Next, we need a tool to rank strategies. Although AHP method solves this problem, this method is not efficient when the factors of dependency exist since AHP analyzes solely independent data. Thus a tool is needed that considers and measures the inter-factor dependencies [6]. In this paper, FANP technic is used to score strategies. Sa ati (1996) introduced a method for multi-criteria decision making which was called analytic network process which offers a model to break complex multi-criteria decision making problems into smaller entities. These smaller entities are rationally scored and combined to make the final decision making [7]. ANP is a technic based on improvement of AHP which considers many feedbacks and mutual relation among criteria and offers accurate calculations for complex models [8]. Structural differences between ANP and AHP are illustrated in the figure below. Entities of a cluster may influence entities of other clusters. A network could be organized as main, middle and low clusters. Network innerrelations are depicted with arrows. Mutual dependency between two clusters is shown with two-sided arrows and is called external dependency and internal dependencies among entities of a cluster are shown with circular arrows [4, 9]. Figure 1. Linear hierarchy

3 Feedback network with entities with internal and external dependencies A circle reveals internal dependency of components in terms of common property Arrow from C4 to C2 shows external dependency of c2 components on c4 components in terms of common property Feedback Figure 2.Network Structure Research method The proposed method for SWOT matrix is Fuzzy ANP technic. This method first identifies matrix components, sub-fields and alternatives and put them in the matrix. By ANP, there are 3 matrices for problem solving which are: 1. Super matrix 2. Weighted super 3. Limit matrix This paper uses super matrix. (1) first row = goal /second row= SWOT factors /third row= SWOT sub-factors row=alternative / fourth Super matrix view which is more famously known as Analytic Network Process has become an attractive tool for better understanding of problems since it overcomes the limitations of hierarchical structures. Such systems can be arranged with a directional network in which a cluster may directly or indirectly be influenced by properties of other components and clusters and influence them. A decision system includes clusters that are identified by C k, K= 1,2,,n and every cluster k has m k entities which are shown by e k1, e k2,, e k m k [8].

4 (2) Proposed ANP algorithm for SWOT The hierarchy and network model proposed in this study for SWOT analysis is composed of four levels, as shown in Fig 4. The goal (best strategy) is indicated in the first level, the criteria (SWOT factors) and sub- criteria (SWOT sub-factors) are found in the second and third levels respectively, and the last level is composed of the alternatives (alternative strategies). Figure 3. SWOT model structure in ANP network Due to verbal variables, triangular numbers are used in calculations so it is assumed that experts would use verbal scales for weighting [3]. Verbal scale of relative importance Triangular fuzzy scale Triangular fuzzy scale in the other side Same Equal importance (1/2,1,3/2) (2/3,1,2) Relatively more important (1,3/2,2) (1/2,2/3,1)

5 More important (3/2,2,5/2) (2/5,1/2,2/3) Very important (2,5/2,3) (1/3,2/5,1/2) Exactly very important (5/2,3,7/2) (2/7,1/3,2/5) Table 1. Verbal scale for assessing relative importance In order to determine strategy priorities by SWOT analysis, proposed algorithm is as follows [10]: Table 2. Proposed steps for ANP method Step Description Relation Identification of SWOT matrix and sub-components and defining strategies by analyzing these subcomponents By assuming that there is no dependency between matrix components, matrix importance score is calculated by fuzzy scoring table Determination of mutual dependencies among SWOT matrix components. Dependency matrix of any SWOT component is determined by considering other components. - Calculation of W 1 Calculation of W 2 4 Determining the importance of SWOT factors Wfactors= W 2 W 1 (3) Determining relative importance level of subcomponents of SWOT matrix by fuzzy scoring table Determining general importance level of SWOT matrix components based on the equation Prioritizing strategy alternatives based on every subcomponents of SWOT matrix based on fuzzy scoring table (calculation of W4) Determining general priorities of strategy alternatives, by considering internal relations among SWOT matrix components by the equation - W sub-factors(global) = W factors W subfactors(local) (4) Calculation of W 4 W alternatives = W 4 W sub-factors(global) (5) Using fuzzy method of ANP in SWOT method for rural medical services Step 1. This section identifies influencing factors for rural medical centers. Internal factors (strengths and weaknesses) and external factors (opportunities and threats) are identified by experts and are defined as components of SWOT matrix and by combining them Strategies of SO, ST, WO,

6 WT are formed and next, these strategies are prioritized and the best strategy is selected. In this regard, SWOT table is first presented [6]. Table 3. SWOT matrix components (S) Having enthusiased physicians Significant growth of medical knowledge and informaition nwtworks in recent years Neccisty of rapid exchange of medical informatino and preventive items Having ICT offices as a base for the plan Having physicians for all fields in villages is not economical Internal Weaknesses (W) Factors Lack of interest by physicians to work in remote and rural areas Shortage of required space for the plan Low population of some villages that makes the plan non-economical for those areas Lack of access to medicine and medical equipment in villages Lack of specific network and site for communication of physicians External Opportunities (O) Bad financial situation of villagers and high costs of medical expenditures in cities Hard access to rural roads Engagement spirit among viallagers and their help to plan Using IRIB channels and relates sites to validate and introduce the plan Support of environmental, medical and road organizations (T) Lack of support by government and private sector Increasing immigration to cities Unreliable and slow internet Risk of hackers Lack of power and telephone lines in some villages and lack of ICT offices Table 4. SWOT matrix Strategies SO ST Strategy WO WT Having physician in viallges, especially the remote ones and establishing video conffrence lins and networks for physicians Establishing volunteer committees to support the plan Support by organnizations such as road and health organizations to have access to medicine in rural areas and elctronic control of the inventory Accurate study of immigration numbers to cities and use of internal networks to solve speed and security problems Which includes 5 strengths and weaknesses and 5 opportunities and threats. Which some of them are explained here? W 4 : lack of medicine and medical equipment in rural areas would lead to dependency of villages to medical services in the cities and therefore, rural medical service will fail.

7 S 5 : Uneconomical nature of assigning physicians with all expertise to rural areas is strength for us since by having a GP in the village and establishing the connection between him and other physicians, this problem would be solved [11]. O 1 : Weak financial situation of some rural areas can help the plan by showing the necessity of medical services for villagers O 2 : Remoteness of some rural areas signifies the importance of medical services for villages. T 2 : Increasing immigration would make the plan uneconomical and it would fail [6]. Step 2. By assuming that there is no dependency among factors of SWOT matrix, these factors are prioritized in pairs by triangular fuzzy number [3]. Table 5. SWOT matrix Components SWOT factors Weaknesses Opportunities (0.39,0.46,0.73) (0.58,0.68,0.92) (0.81,1,1.16) Weaknesses (1.36,2.18,2.53) (0.44,0.61,0.84) (0.38,0.42,0.74) Opportunities (1.08,1.48,1.73) (1.18,1.64,2.26) (1.06,1.33,1.92) (0.86,1,1.23) (1.34,2.14,2.62) (0.52,0.75,0.94) W i Calculation of W i : Consider the fuzzy number of (a,b,c), then W is calculated. Then generated WS are averaged and the averages are summed (W T ). Now WS of every row are divided by WT to get W i. Step 3. In this step, each factor of the matrix is fuzzy compared in pairs in terms of influence of each factor on other factors. Table 6. Internal dependency matrix of SWOT factors for strengths SWOT factors Weaknesses Opportunities Weaknesses (0.97,1.43,2.02) Opportunities (0.49,0.70,1.03) (0.94,1.23,1.88) (0.50,0.70,1.03) (0.53,0.81,1.06) (0.97,1.42,1.98) W i SWOT factors (0.77,1.12,1.63) (0.61,0.89,1.30) W i

8 Table 7. Internal dependency matrix of SWOT factors for weaknesses Table 8. Internal dependency matrix of SWOT factors for opportunities SWOT factors (1.27,1.66,1.91) (0.52,0.60,0.78) W i Table 9. Internal dependency matrix of SWOT factors for threats SWOT factors Weaknesses (0.54,0.88,1.20) Weaknesses (0.83,1.13,1.85) Opportunities (0.51,0.60,0.80) (0.77,1.07,1.30) Opportunities (1.25,1.65,1.96) (0.77,0.93,1.29) W i Therefore, W 2 matrix refers to internal dependency of SWOT matrix components as the following: Step 4. In this step, SWOT factors are prioritized according to their internal dependency. This matrix is generate by the equation below: Step 5. In this step, sub-components of SWOT matrix are ranked based on the previous comparing table. Likewise, these calculations are conducted for three other tables. Matrices are as following:

9 Table 10. Relative importance of Weaknesses Weaknesses W 1 W 2 W 3 W 4 W 5 W i 1. Lack of interest by physicians to work in remote and rural areas (1.19,1.74,1.92) (0.61,1.12,1.55) (1.10,1.66,2.18) (0.97,1.70,2.05) Shortage of required space for the plan (0.52,0.57,0.84) (0.45,0.79,1.31) (0.45,0.60,1.17) (1.09,1.94,2.26) Low population of some villages that makes the plan noneconomical for those areas (0.64,0.89,1.63) (0.76,1.26,2.22) (0.35,0.70,1.24) (1.19,1.40,1.59) Lack of access to medicine and medical equipment in villages (0.46,0.60, 0.90) (0.45,1.66,2.22) (0.80,1.42,2.86) (0.43,0.55,0.86) Lack of specific network and site for communication of physicians (0.48,0.58,1.03) (0.44,0.51,0.92) (0.80,0.93,1.58) (1.16,1.81,2.32) 0.18 Step 6. In this step, SWOT factors that are generated in step 4 are prioritized in subcomponents matrix are multiplied. Results are as following [11]: SWOT factors Table 11. Ranking of subcomponents of SWOT matrix Priority of the factors 5.52 Weakness 5.22 SWOT subfactors Priority of the subfactors Overall priority of the sub-factors (S 1 ) (S 2 ) (S 3 ) (S 4 ) (S 5 ) (W 1 ) (W 2 ) (W 3 ) (W 4 ) (W 5 )

10 Opportunities (O 1 ) (O 2 ) (O 3 ) (O 4 ) (O 5 ) (T 1 ) (T 2 ) (T 3 ) (T 4 ) (T 5 ) Step 7. Determining the relative importance level of strategies based on subcomponents of SWOT matrix. Strategies of every Component of SWOT are prioritized and 20 factors are generated and then W 4 matrix is calculated. Step 8. Finally, priority of strategies is determined by the equation W 4 W (sub-factors (global)) Results of F-ANP shows that SO is the best strategy with total priority score of Conclusion SWOT matrix is the best method to identify influencing factors on organizations. But this matrix is solely capable of identifying these factors. In order to make a managerial decision, we have to understand the extent of influence of these factors on organizational as well as each other to prioritize strategies and implement the best policy. This paper used Fuzzy ANP method which is an improved version of AHP and is capable of prioritizing strategies more accurately. If factors are not dependent, ANP is the best decision model. This means that ANP considers the mutual relations between factors and sub-factors. This issue was studied in medical centers in villages to identify strategies to serve people with least welfare and improve their efficiency. FANP analysis shows that SO is the best strategy with total priority score of (SO: Having physician in villages, especially the remote ones and establishing video conference lines and networks for physician). References [1]Gonjayesh, H., Barghi, H., Ansari Y. (2011). ITC functions reduce trampling the villagers to cities and reduce accidents and traffic problems in Iran. The 1st Conference on Traffic Safety, shahidbahonar University, Kerman. [2]Seidiy, S.E., Hedayatimoghadam Z. (2012). Evaluation of the Role of Rural ICT offices in providing services to the Rural Areasof Isfahan province (Case Study: Seen, Mehregan, Mediseh and kabutarabad villages), Journal of Geography and Environmental Planning, 45(1), [3]Sehat, S., Parizadi, I. (2010). Using network analysis techniques to the analysis of the strengths, weaknesses, opportunities and threats (Case Study: Iran Insurance Company), Journal of Industrial management,

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