Performance Modelling for Maintenance Outsourcing Providers based on the Kano Model

Usually, maintenance activities are carried out by the maintenance department in a company, but now, some companies are outsourcing their maintenance activities. Outsourcing is the delegation of business functions to another company. The advantages of outsourcing include enabling a company to focus on its core business by outsourcing support activities, and changing fixed costs to variable costs. The aim of this research is to develop a multi-criteria performance measurement to assess the performance of maintenance outsourcing providers. Several previous studies have identified suitable performance criteria for maintenance outsourcing providers. However, those studies did not classify the criteria for achieving the desired level of performance. To address these shortcomings, this research has classified the criteria based on the Kano criteria. The criteria are: basic, one-dimensional, indifferent, reverse, and attractive. A managed case study analysis was performed at five Class B private hospitals in East Java to better understand the criteria in terms of the needs of a real hospital maintenance department. Previous research studies focused on understanding the relationship between each criterion and the associated level of performance, whereas the current research has focused instead on the relationship links between the criteria and the weighting of each criterion using DEMATEL-ANP. The outcome of this study is a simple instrument that can be directly used to evaluate the performance of maintenance outsourcing providers.

Case study analysis; ICU; KANO; Medical devices; Outsourcing

Patient safety is a construct that implies behaviour that is intended to minimise the risk of harm to patients through both system effectiveness and individual performance, and is designed to avoid injuries to patients from the care that is intended to help them. Harm is an unintended physical injury resulting from or contributed to by medical care that requires additional monitoring, treatment, or hospitalisation, or that results in death (Albrecht, 2015). It is crucial that the maintenance service provider has a high enough performance level in order to achieve that goal. The aim of this study is to develop a performance measurement model to assess maintenance outsourcing providers. In the healthcare industry in Indonesia, the performance measurement of maintenance service providers has not been performed and there is no systematic method of performance measurement. Performance measurement of the maintenance service provider is important. If the maintenance service provider has a good level of performance, then the availability and reliability of the medical equipment can be maintained. If the performance or performance of the maintenance service provider is not measured and evaluated, then there is the possibility of the service providers not improving their performance. According to Jackson and Pascual (2008) in Cruz and Rincon (2012), research on maintenance service outsourcing focusing on the integration of provider maintenance selection, performance evaluation and measurement has not been performed. Cruz and Rincon (2012) conducted a themed mapping review on previous studies on outsourced maintenance in the healthcare industry area. These earlier studies are broadly divided into four categories, namely mathematical models, conceptual research, empirical research on maintenance outsourcing for medical equipment, and empirical research on maintenance outsourcing in other fields. Almeida (2005) conducted a study on maintenance contract issues related to decision-making. In making decisions, decision makers choose alternatives based on the main criteria of cost and performance. Cruz et al. (2013) conducted research on the performance criteria of the maintenance service providers. The object of this research is more specific, as it is about the maintenance of medical equipment.

2.    METHODS

2.1.    Performance Measurement

Performance measurement is defined as a quantitative indicator that can be used to measure a particular goal (Dewangan & Godse, 2014; Yildiz & Demirel, 2014). In hospital, the performance of the maintenance outsourcing providers is directly related to patient safety. So, the performance of the maintenance outsourcing providers should be managed. The first step is to gather suitable criteria to use in the measurement process.

2.2.    Criteria Development

The initial criteria in this study were gathered from a review of the literature. Then, the list of criteria was grouped into similar criteria (Almeida, 2005; 2007). Service quality is defined as the degree of error that occurs when a repair has been carried out, the expected condition of the equipment, and average customer satisfaction (Almeida, 2005; Almeida, 2007; Singgih & Dalulia, 2016). Therefore, service quality can be understood to have a comprehensive meaning, which refers to the level of customer satisfaction with the services of the maintenance outsourcing provider that can be identified by the degree of error when the maintenance activities have been carried out. The details of the criteria obtained from a review of the previous research has been illustrated in Table 1.

The next step after gathering the criteria from the literature was to choose what the suitable criteria are for the ICU hospitals in East Java. This was explored through a case study analysis (Wahjudi et al., 2016) that was conducted in 5 private hospitals, in which the head of the maintenance department in each hospital served as an expert in this research.

Table 1 Criteria obtained from the literature study

By integrating several methods, namely case study analysis, Delphi, Kano, DEMATEL, and ANP, a performance model was developed which can be used by the healthcare industry to assess the performance of their maintenance outsourcing providers. The resulting performance criteria can be used as a reference when assessing the performance of general outsourcing. Case study analysis and Delphi was used to determine new criteria based on the needs of the user, Kano was used to identify criteria for the basic and special dimension requirements, DEMATEL was used to determine linkages between the criteria, and ANP was used to weight the criteria. The results obtained from the Kano method indicated that the criteria that must be fulfilled (basic requirements) must also provide flexibility in terms of abnormal situations and the type of equipment that can be handled by the provider (equipment types). The three criteria that had the highest weighting were the criterion of technician skill at 0.256881, the criterion for diagnostic accuracy at 0.222181, and the criterion of flexibility at 0.175684. The two criteria that were assigned a weight of 0 (meaning that they did not contribute to performance) were the criteria of cost and dependability.

This research can be completed because of funds from Kementerian Riset, Teknologi, dan Pendidikan Tinggi, with contract number: 010/SP2H/LT/DRPM/IV/2017.

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