11 e CONGRES INTERNATIONAL DE GENIE INDUSTRIEL – CIGI2015 Québec, Canada 26-28 octobre 2015 Abstract – The risk or chance of undesirable outcomes during the procedure is widely used in different areas in health care. However, its’ application in prioritization of patients is not currently reported in the literature or practice. This paper focuses on the significance of risk in prioritization of patients, and proposes an innovative framework for prioritization of patients considering uncertainties, group decision making, and associated risk that may threaten patients’ health during waiting time. An illustrative example shows that using the proposed framework, decision makers can easily classify patients for surgery according to their criticality. In the lights of the proposed framework, decision makers can; i) manage waiting lists properly, ii) consider several medical professionals’ opinions iii) handle uncertainty, iv) increase quality of care, equity and patients’ safety, and v) diminish rate of injuries and mortality due to long waiting times. Moreover, this framework can be adopted in other departments in hospitals such as emergency departments, or even other healthcare organizations such as rehabilitation centers, medical clinics and etc. Keywords –Risk Analysis; Prioritization; Surgical waiting list; Uncertainty; Group Decision Making. 1 INTRODUCTION Limited and delayed access to care for patients is a multifaceted and universal problem in public health. Long waiting lists are one of main complaints of surgical patients (Abbasgholizadeh Rahimi, Jamshidi, Ruiz, & Ait-Kadi, 2014). After patients are referred for surgery, their situations are examined if they have non-life threatening condition they will be admitted on a first-come, first serve basis. But, if their conditions are potentially life-threatening, they will be entered into a priority waiting list (Randolph, 2013). Higher priority-patients will be selected for service ahead of those with a lower priority, regardless of when they are placed on the list. And, the same priority patients are ranked in the arrival order (Randolph, 2013). Prioritization of patients on waiting lists and their access to treatment based on various factors is one of the major issues within healthcare organizations. According to US National Library of Medicine, (Medicine, n.d.) access to treatment is defined as “the degree to which individuals are inhibited or facilitated in their ability to gain entry to, and to receive care and services from the health care system”. Fraser Institute (Barua & Esmail, 2013) reported that the total waiting time in Canada in 2013 was 95 % longer than in 1993. And also Russell et al. (Russell, Roberts, Williamson, Jolly, & McNeill, 2003) in their recent study indicated an increasing imbalance between the demand for, and availability of access to elective surgery for lower urgency elective procedures. This imbalance causes long waiting time and consequently, waiting of some patients longer than clinically recommended waiting times (Russell, Roberts, Williamson, Jolly, & McNeill, 2003). In many medical procedures, these long waiting times affect directly on patients’ health and quality of care. Reports regarding the harms related to long wait times are increasing; these harms include poorer medical results from care and an increased risk of adverse events (Barua & Esmail, 2013). Fraser Institute estimated, 44273 Canadian women have lost their lives between 1993 and 2009 as a result of lengthy delays in receiving care (Esmail, 2013). Day (Day, 2013) also indicated that “for some diseases delayed treatment can cause reduction in effectiveness of treatment, and often transforms an acute and potentially reversible illness or harm into a chronic, irreversible condition that involves permanent disability”. Prioritization is a complex decision making process, and as a result scoring systems (i.e. explicit criteria and weights), have been designed as a decision making tool to guide the surgeons and clinicians to a decision. A scoring system or points system consists of criteria for deciding patients’ relative priorities for treatment. Each patient is “scored” on the criteria and their corresponding point values summed to get a “total score”, by which patients are ranked relative to each other. An example of a scoring system for prioritizing patients for coronary artery bypass graft (CABG) surgery is illustrated in (Figure 1) (Hansen, Hendry, Naden, Ombler, & Stewart, 2012). Scoring systems were SAMIRA ABBASGHOLIZADEH RAHIMI 1 , AFSHIN JAMSHIDI 1 , DAOUD AIT-KADI 1 , ANGEL RUIZ 2 1 Department of Mechanical Engineering, Université Laval, Quebec, Canada samira.abbasgholizadeh-rahimi.1@ulaval.ca, afshin.jamshidi.1@ulaval.ca, Daoud.Aitkadi@gmc.ulaval.ca, 2 Department of Administration, Université Laval, Quebec, Canada angel.ruiz@fsa.ulaval.ca, A Fuzzy Dynamic Risk-based Approach for Prioritization of Surgical Patients