Journal of Cleaner Production 139 (2016) 1001e1010

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Journal of Cleaner Production

journal homepage: www.elsevier.com/locate/jclepro

A hybrid multi-criteria decision making method approach for

selecting a sustainable location of healthcare waste disposal facility
Ankur Chauhan*, Amol Singh
Department of Operations Management, Indian Institute of Management Rohtak, MD University Campus, Rohtak, Haryana, 124001, India

a r t i c l e i n f o a b s t r a c t

Article history: Sustainability is the concern of organisations across the world; it has received attention of researchers
Received 13 May 2016 from different fields including operations management. For addressing sustainability, the triple bottom
Received in revised form line approach of environmental, societal, and economic sustainability has been widely mentioned in the
19 August 2016
literature. Since, the nature of healthcare waste is hazardous and infectious for environment and society;
Accepted 20 August 2016
therefore, the careful disposal of this waste becomes an essential task for waste disposal firms. Along
Available online 27 August 2016
with this, the stringent guideline of world health organisation as well as National and State policies
regarding the disposal of healthcare waste makes it a typical to do business. Therefore, to make it sus-
Keywords:
Healthcare waste management
tainable and affordable, in the present study the criteria related to the sustainability's triple bottom line,
Multi criteria decision making including other criteria, have been identified from literature review and field survey for the selection of a
ISM sustainable location of healthcare waste disposal facility. Moreover, a hybrid method of interpretive
Fuzzy set theory structural modelling, fuzzy analytic hierarchy process, and fuzzy technique for order preference and
AHP similarity to ideal solution has been used to carry out this study. Therefore, the present work makes the
TOPSIS theoretical, in terms of criteria, as well as methodological contribution, hybrid method, for the selection
of a sustainable location of healthcare waste disposal facility.
© 2016 Elsevier Ltd. All rights reserved.

1. Introduction
In the last four decades the population across the world has
increased rapidly, especially in developing countries. The rapid
increase in population has created numerous problems which have
severe impact on the health of humans and animals. One such
problem is the disposal of huge quantities of healthcare waste
(HCW)which comes from clinics, pathology labs, nursing homes,
and hospitals; this waste include syringes, blooded cottons, ban-
dages, scalpels, body parts, chemicals, cytotoxic, and radioactive
elements (Pruss, 2014; WHO, 2013).
Since, healthcare waste consist of harmful components; there-
fore, it has been categorised under hazardous and infectious wastes
by different environmental bodies and researchers across the world
(O'leary et al., 2002; Pruss et al., 1999; SBC, 2013). The bio-medical
waste, management and handling, rules vividly states that the
collection and disposal of healthcare waste should be carried out
with the help of a licenced healthcare waste disposal firm (MOEF,
2016; The Gazette of India (1998)). The healthcare waste disposal
* Corresponding author.
E-mail addresses: chauhan.ankur2903@gmail.com (A.
amolasingh2007@rediffmail.com (A. Singh).
firm collects the waste from different hospitals in its region, such as
Mandawar Pollution Control Committee (MPCC) which is a waste
disposal firm in Uttarakhand; it collects the waste from more than
400 clinics, pathology labs, and hospitals. Additionally, the amount
of healthcare waste collected for treatment and disposal is
increasing rapidly (IndiaStat, 2013); therefore, the HCW disposal
firm has to select a sustainable location to establish a facility for
daily storage, treatment and disposal of healthcare waste (Chauhan
and Singh, in press).
The facility location problems have been studied in the areas
such as supply chain management which addresses the issues
regarding determination of a company's manufacturing, ware-
house, and distribution centre location (Almeida et al., 2013;
Ertugrul and Karakasoglu, 2008; Melo et al., 2009). Few more ex-
amples include the decision about the location of a hospital, loca-
tion of waste collection bins in a hospital campus, etc.
(Andrinopoulos et al., 2016; Melo et al., 2009; Nolz et al., 2014).
Ertugrul and Karakasoglu (2008) described in their study that the
facility location problem is multi-criteria in nature and it depends
on some basic criteria such as availability of labour. However, in
case of a hazardous and infectious waste such as HCW, it cannot be
limited to some basic criteria. The consideration of the criteria apart
Chauhan), from basic criteria, to select a location for the establishment of a
healthcare waste disposal facility, would facilitate the decision

http://dx.doi.org/10.1016/j.jclepro.2016.08.098
0959-6526/© 2016 Elsevier Ltd. All rights reserved.
1002 A. Chauhan, A. Singh / Journal of Cleaner Production 139 (2016) 1001e1010
makers to achieve an environmentally, socially, and economically,
sustainable location (Ertugrul and Karakasoglu, 2008; Govindan
et al., 2013; Porter and Kramer, 2007).
The evolution of sustainability issues among organisations may
be attributed to the depletion of natural resources, lack of stringent
legislations, and poor support of the managers in sustainable de-
cision making (Calabrese et al., 2016; Govindan et al., 2013; Hart
and Milstein, 2003). However,Dao et al. (2011) mentioned sus-
tainability as an essential factor for long-term development and
growth of a company which encourages the management re-
searchers and practitioners for working upon the issues such as the
selection of a sustainable location for healthcare waste disposal
facility. Since, the selection of a sustainable location is a multi-
criteria decision making problem of multi-attribute decision mak-
ing type which has been discussed ahead, in Section 2. The appli-
cation of hybrid method would help in identifying a sustainable
location for healthcare waste disposal. The selection of a sustain-
able location would be beneficial for healthcare waste disposal firm,
society, and environment, i.e. in terms of business, less exposure to
public, and the reduction the usage of natural resources such as
land, water and carbon emissions, respectively. Moreover, the
hybrid method has been applied on the eight criteria identified
from literature review and field survey.
The rest of the paper has been organised as follows: The hybrid
method of interpretive structural modelling (ISM), fuzzy analytic
hierarchy process (AHP), and fuzzy techniques for order preference
and similarity to ideal solution (TOPSIS)has been given in Section 3
i.e. Research methods. The application of the hybrid method would
help in the achievement of a better solution with less complexity
(Beikkhakhian et al., 2015a). Areal case study from India has been
detailed to apply the hybrid MCDM approach in Section 4. The re-
sults and discussions of the case study have been given in Section 5.
The conclusion of the study has been given in Section 6. The im-
plications of the study have been provided in Section 7. Section 8
details the limitations and future research directions.
2. Literature review of the facility location problems and
criteria identification
From the recent literature reviews regarding facility location
problems it has been observed that most of the problems under
location science have been discussed in multi-criteria decision
making (MCDM) environment (Farahani et al., 2010; Melo et al.,
2009). The MCDM problems have been noticed as the combina-
tion of multi objective decision making (MODM) and multi attri-
bute decision making (MADM). The MODM problems are such that
it tries to develop the best alternative with the help of a set of
Table 1
The detailed description of each criterion.
S.No. Criteria Explanation of criteria
1 Distance (C1) Distance of waste disposal facility from waste collection point
2 Waste disposal site The proximity of waste disposal site to population
exposure to public (C2)
3 Availability of land (C3) Availability of land (landfilling space) for disposal of healthcare waste
4 Cost (C4) Cost of transportation of HCW to disposal facility
5 Sensitivity towards The environmental friendliness of a facility location in terms of land usage, water, air, and
environment (C5) emissions, etc.
6 Quantity of HCW for The weight or quantity of HCW for final disposal
disposal (C6)
7 Area covered by HCW The area dedicated to a particular HCW disposal facility
disposal site (C7)
8 Road condition (C8) The connectivity of Healthcare waste collection point to HCW disposal facility. The poor
condition of road leads to more carbon emission, poor mileage, and high cost.
quantifiable objectives, well defined constraints, and trade off in-
formation (Farahani et al., 2010). The studies which have been
conducted to address the issue of waste disposal facility location
majorly consider the multi-objective decision making techniques
such as linear programming (Alumur and Kara, 2007; Rakas et al.,
2004).
In contrast to the MODM problems, the MADM problems have a
few numbers of predetermined alternatives. In MADM problems
the alternatives satisfy a specified level of objectives and the de-
cision makers are supposed to choose the best alternative. More-
over, in the literature, the application of MADM techniques have
been considered as an important method to solve facility location
problems for addressing the sustainability issues such as societal
(Ertugrul and Karakasoglu, 2008; Farahani et al., 2010; Kahraman
et al., 2003b; Melo et al., 2009). Kahraman et al. (2003b) applied
the fuzzy analytic hierarchy process method to address the problem
of choosing a location for the establishment of a motor company.
Multi-objective decision making problems can be single criteria
or multiple criteria, however, the multi-attribute decision making
problems are based on multiple criteria only (Farahani et al., 2010).
Since, the present study is an MCDM problem of MADM type which
has been carried out to address the issue of selection of a sustain-
able location for healthcare waste disposal facility establishment;
therefore, the multiple criteria have been identified from literature
review and field survey. The study conducted by Ertugrul and
Karakasoglu (2008)described the general multiple criteria involved
in the selection of a location of a facility i.e. distance to markets,
distance to resources (raw material), people engagement (interest)
for facility establishment, and facilities provided to working staff.
Additionally, Farahani et al. (2010) carried out the review of liter-
ature on facility location problems and described the various
multiple criteria involved in the decision making as cost; product
value; risks to environment such as sound pollution, air or water
pollution, smells; utilization of facility and accessibility to re-
sources; completion; political matters and legal regulations. How-
ever, there is no specific study which could be reviewed for the
identification of criteria of healthcare waste disposal facility
location.
As described previously, the sustainability decisions are mainly
based on environmental, societal, and economic dimensions. In this
study, the environmental sustainability included the technology for
treatment and disposal, final disposal method of ashes, water us-
age, etc. For economic sustainability, the cost of installation and
maintenance of machines, cost of transportation, labour cost, and
fuel cost, etc. And the societal sustainability the criteria included
the exposure of healthcare waste disposal facility to public, health
of workers, the quantity of healthcare waste for disposal, area
Reference
(Erkut and Susan, 1989), (Ioannis, 1998),
(Ertugrul and Karakasoglu, 2008)
Field survey
(Erkut et al., 2008),
(Rakas et al., 2004), (Arvind and S.K., 1999)
(Alumur and Kara, 2007), (Kumar et al.,
2008), (Erkut et al., 2008),
Field survey
(Cohon, 2013)
(Cantarella and Vitetta, 2006)
 A. Chauhan, A. Singh / Journal of Cleaner Production 139 (2016) 1001e1010
covered by the facility, etc. Apart from this, the road condition (road
network), and availability of land have been studied. The criteria
mentioned in Table 1 are listed with their generic names because all
criteria could not fit under the environmental, social, and economic
umbrella's triple bottom line approach.
3. Research methods
Beikkhakhian et al. (2015) applied the hybrid method and stated
that the ISM method helps in understanding the inter-relationships
and filtration of criteria; fuzzy AHP for computing the weights of
filtered criteria and fuzzy TOPSIS for the ranking of alternatives
(locations). Additionally, the application of a hybrid multi-criteria
decision making method enhances the results of a study (Taylan
et al., 2014). Ertugrul and Karakasoglu (2008) conducted a
comparative study to rank the alternatives with the help of (a) only
fuzzy AHP method and (b) a hybrid method of fuzzy AHP and fuzzy
TOPSIS; the findings of the study revealed that the hybrid method
results into a less complex and better output model, whereas, the
former results into a complex computations due to an increasing
number of pairwise comparison matrices. Therefore, the hybrid
method of interpretive structural modelling (ISM), fuzzy analytic
hierarchy process, and fuzzy technique for order preference and
similarity to ideal solution (TOPSIS) has been applied for the se-
lection of a sustainable HCW disposal facility location.
The diagrammatic representation of methodological flow of the
present study has been given in Fig. 1.
3.1. The interpretive structural modelling (ISM) method
Warfield (1973, 1974)proposed the ISM method to act as a
communication tool in the complex situations. The mathematical
foundation of this methodology lays in the reference works carried
out by various researchers (Frank et al., 1988). The ISM method has
been applied in various areas such as supply chain management
(Jharkharia and Shankar, 2005), risk management (Sagheer et al.,
2009), and quality management (Debnath and Shankar, 2012).
The application of ISM method assists in understanding the inter-
relationships among the criteria. In addition to this, it helps in
the filtration of most important criteria, with the help of an ISM
digraph and MICMAC analysis, for the application of integrated
methods such as fuzzy AHP and fuzzy TOPSIS (Beikkhakhian et al.,
2015b; Kannan et al., 2013). The steps of the ISM method have been
detailed below:
Step 1: To identify the criteria, specific to the problem, from
literature survey and interview with domain experts including
members from academic institutions.
Step 2: To establish the relationship between each pair of
criteria which are identified in step 1.
Step 3: A structural self-interaction matrix (SSIM) is developed
which depicts the pair wise relationships among the criteria
under consideration.
Step 4: The development of reachability matrix from SSIM is
carried out in this step. To do so,SSIM is converted into the initial
reachability matrix by substituting the four symbols i.e., V, A, X
or O, of SSIM by 1 or 0 in the initial reachability matrix and it is
checked for transitivity. The transitivity is incorporated, if
missing, by re-evaluation of responses to obtain final reach-
ability matrix.
Step 5: The reachability and antecedent sets are derived from
the final reachability matrix to partition it into different levels.
The reachability set consists of the criteria which are driven by a
particular criterion; whereas, the antecedent set consists of the
criteria which drives to other particular criterion.
1003
Fig. 1. Methodological flow of the study.
Step 6: The ISM digraph is drawn with the help of reachability
matrix and different levels obtained in step 4 and step 5
respectively. To show the direct relationships, the transitive
links are removed.
Step 7: The final digraph is converted into an ISM model by
replacing nodes of the criteria with statements.
Step 8: The ISM model is checked for conceptual inconsistencies,
if required the changes are made.
Step 9:MICMAC analysis: This analysis is performed to under-
stand the nature of dependencies among the drivers and de-
pendents of the study. On the basis of driving and dependence
power of the criteria one of the four names, i.e. Autonomous,
Dependent, Linkage, and Independent drivers, may be labelled
to each criteria (Arcade et al., 1999).
3.2. Fuzzy set theory
Zadeh (1965) introduced the concept of fuzzy set theory to
capture the uncertainties, vagueness, and ambiguity of human re-
sponses, subjective judgements, for various real world situations.
Fuzzy set theory manages imprecise data as probability distribu-
tions in terms of defined memberships which results into an input
for logical reasoning. Furthermore, Zimmermann (1978, 1983)
emphasised on the application of fuzzy set theory in the field of
operations research which included the works such as fuzzy linear
programming.
Let Z be the universe of discourse, Z ¼ {z1, z2, z3, z4, … …,zn}, a
fuzzy set ~S of Z is defined by a membership function pS ~ (z), which
is related to each element z in Z a real number in the interval [0,1].
The value of function pS ~ (z) is termed as the grade of membership
of z in ~
S.
3.2.1. Fuzzy numbers
There are different types of fuzzy numbers in practice today. But
Triangular and Trapezoidal fuzzy numbers are the most promi-
nently used fuzzy numbers in theory and practice (Liu and Wang,
2007). Due to the easiness in calculation triangular fuzzy
numbers are more in practice (Taylan et al., 2014). Therefore, in the
present study, triangular fuzzy numbers have been preferred to
1004 A. Chauhan, A. Singh / Journal of Cleaner Production 139 (2016) 1001e1010

represent the linguistic variables. A triangular fuzzy number ~ S can tackling the absolute or unambiguous responses; and Chang (1996)
be represented as (p, q, r) and its membership function pS (z) can be proposed the application of synthetic extent analysis method of
given as follows: fuzzy AHP which has been applied in this study. The fuzzy AHP
8 9 approach helps in capturing the vagueness or ambiguity of the
>
> 0; z < p >
> decision making problems (Taylan et al., 2014; Yu, 2002). The
>
> >
>
>
> z  p >
> application of fuzzy set theory with AHP results into the more
>
> >
>
< ; p  z  q>
>
= effective and appropriate decision making in comparison to the
qp
pS ðZÞ ¼ (1) conventional AHP (Lee et al., 2008). Fuzzy AHP has been widely
>
> rz >
>
>
> ; qzr> >
>
> used in different fields such as project selection, supply chain
>
> r  q >
>
>
> >
> management, and reverse logistics (Ji, 2008; Kahraman et al.,
: 0; z > r ;
2003a; Taylan et al., 2014). Additionally, the application of fuzzy
AHP in addressing the contemporary issues includes the sustain-
Where p  q  r and p, q, r represents the least possible value, able assessment of energy planning and materiality assessment in
most possible value, and the largest possible value of a fuzzy event, sustainable reporting (Calabrese et al., 2016; Luthra et al., 2015).
respectively. The steps for Fuzzy AHP method has been given below:
Let z1 ¼ (p1, q1, r1), z2 ¼ (p2, q2, r2) are two positive triangular
fuzzy numbers and k is a real number. Zadeh (1965) described that Step 1: The triangular fuzzy comparison matrix is expressed by:
the algebraic operations on any two fuzzy numbers z1 and z2 can be
given as: 2 3
 ð1;
 1; 1Þ
  ðp12 ; q12 ; r12 Þ ðp1n ; q1n ; r1n Þ
z1 þ z2 ¼ ðp1 þ p2 ; q1 þ q2 ; r1 þ r2 Þ; (2) ~ ¼ Z n  n4 p ; q ; r
Z ð1; 1; 1Þ ðp2n ; q2n ; r2n Þ 5
ij 21 21 21
ðpn1 ; qn1 ; rn1 Þ ðpn1 ; qn1 ; rn1 Þ ð1; 1; 1Þ
z1  z2 ¼ ðp1  p2 ; q1  q2 ; r1  r2 Þ; (3) (10)

z1 *z2 ¼ ðp1 *p2 ; q1 *q2 ; r1 *r2 Þ; (4) Where zij ¼ (pij, qij, rij)

X ¼ {x1, x2, x3, x4, xn} … … … … … … object set

K*z1 ¼ ðK*p1 ; K*q1 ; K*r1 Þ; And K*z2 ¼ ðK*p2 ; K*q2 ; K*r2 Þ;
T ¼ {t1, t2, t3, t4, tm} … … … … … … target set
(5)
  Mti1 ; Mti2 ; Mti3 ; …Mti1 ; i ¼ 1; 2; 3…; n; (11)
z1 ðp1 ; q1 ; r1 Þ p1 q1 r1
¼ ¼ ; ; ; (6)
z2 ðp2 ; q2 ; r2 Þ r2 q2 p2 Where all the
j
Mti (j ¼ 1, 2, 3 …. . n)are triangular fuzzy numbers.
   
1 1 1 1 1 1 Step 2: The value of fuzzy synthetic with respect to the ithobject
ðz1 Þ1 ¼ ; ; ; And ðz2 Þ1 ¼ ; ; ; (7) is defined as
r1 q1 p1 r2 q2 p2

(K is a positive real number) Xm hXn Xm i1

The equations (2)e(7) shows the addition, subtraction, multi- Si ¼ j¼1
Mtij * i¼1
Mj
j¼1 ti
(12)
plication, multiplication with a constant, division, and inverse op- Pm j
erations, on fuzzy numbers, respectively. To find j¼1 Mti , the fuzzy addition operation of m extent
The distance between two fuzzy numbers can be measured by analysis values is performed for a particular matrix such that
using the vertex method (Heilpern, 1997; Hsieh and Chen, 1999).
0 1
Therefore, the distance between two fuzzy numbers z1 and z2 can X
m X
m X
m X
m
¼@ rj A
j
be given as: Mti pj ; qj ; (13)
rffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi j¼1 j¼1 j¼1 j¼1
2 1
h i
dd ¼ ðp1  p2 Þ2 þ ðq1  q2 Þ2 þ ðr1  r2 Þ2 (8) P P j 1
3 And to find ½ ni¼1 m j¼1 Mti  , the fuzzy addition operation of m
extent analysis values is performed for a particular matrix such that
According to Hsieh and Chen (1999) de-fuzzification of a fuzzy
number z1 ¼ (p1, q1, r1) can be defined as: Xn 
Xn Xm j
Xn Xn
Mti ¼ p;
i¼1 i
q;
i¼1 i
r
i¼1 i
(14)
p1 þ 4q1 þ r1 i¼1 j¼1
DðZ1 Þ ¼ (9)
6 Therefore, the inverse of eqn. (14) would be given by:

hXn Xm i1  
3.2.2. Linguistic variables 1 1 1
Mj ¼ Pn ; Pn ; Pn (15)
The variables which can be expressed in linguistic terms are i¼1 j¼1 ti
i¼1 ri i¼1 qi i¼1 pi
called linguistic variables. The linguistic terms are very useful in
ambiguous, imprecise, and vague situations. In the present study,
the linguistic variables used for fuzzy AHP and fuzzy TOPSIS process
have been detailed in Appendix A. Step 3: The degree of possibility of M2 ¼ (p2, q2, r2)  M1 ¼ (p1,
q1, r1) is defined as
3.3. Fuzzy analytic hierarchy process (fuzzy AHP)

VðM2  M1 Þ ¼ sup½min mM1 ðxÞ; mM1 ðyÞ (16)
The AHP method was proposed by Saaty (1980), to help the
decision makers in multi-criteria decision making environment for Hence, it can be equivalently expressed as follows:
 A. Chauhan, A. Singh / Journal of Cleaner Production 139 (2016) 1001e1010 1005

VðM2  M1 Þ ¼ hgtðM1 ∩M2 Þ ¼ mM2 ðdÞ kij

8 Pij ¼ qffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
Pm 2 i ¼ 1; 2; 3…; m; j ¼ 1; 2; …; n (20)
>
> 1 if q2  q1
>
> i¼1 kij
>
>
< (17)
0 if p2  r2
¼
>
>
>
> p1  r2 Step 2: Compute the weighted normalized decision matrix. The
>
>
: otherwise weighted normalized value vij is calculated as
ðq2  r2 Þ  ðq1  p1 Þ

Where d is the ordinate of the highest intersection point D be-
tween mM1 and mM2 (given in Fig. 2). To compare M1 and M2, the
values of V (M1  M2) and V (M2  M1) are needed.
Step 4: The possibility degree for a convex fuzzy number greater
than k convex fuzzy Mi (i ¼ 1,2,3,4, … ,k) is defined by the following
equations:
VðM  M1 ; M2 ; M3 ; …Mk Þ
¼ V½ðM  M1 Þ; ðM  M2 Þ; ðM  M3 Þ; …; and ðM  Mk Þ;
vij ¼ wj x pij ; i ¼ 1; 2; 3…; m; j ¼ 1; 2; …; n (21)
where wj is the weight of the jth attribute or criterion, and
Pn
j¼1 wj ¼ 1
Step 3: The positive ideal (Aþ) and negative ideal (A-) solution is
determined in this step. The solutions, Aþ and A-, are deter-
mined in terms of weighted normalized values.
 
n o
   
max  max 
¼ Min V ðM  Mi Þ; i ¼ 1; 2; 3…k: Aþ ¼ vþ ; vþ
; …; vþ
¼ v i2B ; v i2C ;
1 2 n j ij  j ij 
(18)
(22)
Assume that
n o
     
max  max 
0
d ðAi Þ ¼ min V ðSi  Sk Þ (19) A ¼ v  
1 ; v2 ; /; vn ¼ vij i2B ; vij i2C ;
j j
For k ¼ 1, 2, 3, … …,n; k s i. (23)
In the present study, we have applied the Fuzzy-AHP technique
Where, B is associated with benefit criteria, and C is associated
to compute the weights of the criteria. Additionally, to rank the
with cost criteria.
sustainable location for the establishment of HCW disposal facility,
on the basis of the criteria, the technique for order preference by
Step 4: Compute the distance measures i.e.dþ i
and d
i , using the
similarity to ideal solution (TOPSIS) has been applied. Therefore, a
n-dimensional Euclidean distance. The distance of each alter-
detailed description of TOPSIS has been given ahead.
native from the positive ideal solution is given as
sffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi

X 
3.4. Fuzzy technique for order preference and similarity to ideal
n
2 
solution (fuzzy TOPSIS) dþ þ
2
i
¼ j¼1 ij
v  v j
i ¼ 1; 2; 3…; m (24)

Hwang and Yoon (1981) proposed the TOPSIS method as a multi

Similarly, the distanceof each alternative from the negative ideal
criteria decision making method which could help in identifying
solution is computed by equation (25).
the solution from finite set of points. Since, the introduction of
TOPSIS, it has been applied in various management areas such as v8ffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
9ffi
u
Supply Chain Management and Logistics. TOPSIS is a multiple u< X n  2 =
u
2
criteria method to identify solutions from a finite set of alternatives. d
i ¼ t: vij  v i ¼ 1; 2; 3…; m (25)
j ;
The basic principle is that the selected alternative should have the j¼1
shortest distance from the positive ideal solution and the farthest
distance from the negative ideal solution (Shih et al., 2007). The
application of fuzzy set theory principles to TOPSIS method results
into fuzzy TOPSIS. Fuzzy TOPSIS helps to address the ambiguity or Step 5: Compute the relative closeness (RC) to the worst or best
imprecision of decision makers in selecting a particular alternative ideal solution, in this case it is calculated from the worst solu-
(Wang and Chang, 2007). The procedure of fuzzy TOPSIS can be tion. Hence, the relative closeness of an alternative Ai, from
expressed in a series of steps (Hwang and Yoon, 1981): worst solution, with respect to Aþcan be obtained by using the
þ
calculated values of di and di in equation (25).
Step 1: Compute the normalized decision matrix. The normal-
ized value pij is calculated as d
i
RC ¼ (26)
dþ
i
þ d
i

Since dþ
i
 0 and d
i  0, therefore, it is evident that the value of
RC would fall between 0 and 1, i.e. RCε ½0; 1.

Step 6: Rank the preference order. For ranking alternatives using

this index, we can rank alternatives in decreasing order.

The basic principle of the TOPSIS method is that the selected

alternative should have the “shortest distance” from the positive
ideal solution and the “farthest distance” from the negative ideal
Fig. 2. The intersection between M1 and M2. solution.
1006 A. Chauhan, A. Singh / Journal of Cleaner Production 139 (2016) 1001e1010

4. Case study Table 3

Reachability matrix.

The present case study has been carried out to facilitate a C8 C7 C6 C5 C4 C3 C2 C1 Driving power
healthcare waste disposal firm for the selection of a sustainable C1 1 1 1 0 1 0 1 1 6
location of healthcare waste disposal site. The management of C2 0 0 0 1 1 0 1 0 3
healthcare waste disposal firm is concerned about the disposal of C3 0 1 0 1 0 1 1 1 5
this hazardous and infectious healthcare waste. Therefore, the firm C4 0 1 1 0 1 0 0 1 4
C5 0 1 1 1 1 0 0 0 4
has been looking forward to its long term planning for a healthcare
C6 0 0 1 1 0 0 0 1 3
waste disposal facility location. As discussed earlier, the location of C7 0 1 1 0 0 0 0 1 3
a healthcare waste disposal facility is associated with several fac- C8 1 1 1 1 1 1 1 1 8
tors which have been termed as criteria in this study. Additionally, Dependence power 2 6 6 5 5 2 4 6
the selection of best sustainable location, among the seven loca-
tions, for healthcare waste disposal facility has been considered as
the prime objective of this study. This case study has been carried
Table 4
out in the Garhwal region of Uttarakhand, India. The levels obtained by each criterion.

Criteria Reachability set Antecedent set Intersection Level

C1 1,2,4,6,7,8 1,3,4,6,7,8 1,4,6,7,8 VI

4.1. Application of ISM method C2 2,4,5 1,2,3,8 2 V
C3 1,2,3,5,7 3,8 3 VII
C4 1,4,6,7 1,2,4,5,8 1,4 III
The ISM method has been applied to reveal the inter-
C5 4,5,7 2,3,5,6,8 5 IV
relationships among eight criteria. The structural self-interaction C6 1,5,6 1,4,5,6,7,8 1,6,5 I
matrix (SSIM) obtained from the group decision making of ex- C7 1,6,7 1,3,4,5,7,8 1,7 II
perts has been given in Table 2. The SSIM has been converted into C8 1,2,3,4,5,6,7,8 1,8 1,8 VIII
reachability matrix, by replacing V, X, A, and O to 1, 1, 0, and
0 respectively, which has been provided in Table 3. After reach-
ability matrix various iterations have been performed which results
into eight levels for eight criteria as shown in Table 4. On the basis
of the levels obtained in Table 4, the ISM digraph has been prepared
in Fig. 3 which shows the inter-relationship among the criteria.

4.1.1. MICMAC analysis

The MICMAC analysis helps to understand the nature of each
criterion by clustering them in four clusters i.e. autonomous driver,
dependent driver, linkage driver, and independent driver.
Furthermore, the criteria filtration becomes easier by using
MICMAC analysis. In Fig. 4 criteria C6 and C7 can be stated as the
most dependent drivers which would be eliminated further.
Therefore, in the above mentioned Figs. 3 and 4 i.e. digraph and
MICMAC analysis, Road condition can be noticed as the most
prominent driver. In addition to this, availability of landfilling
space, distance of hospitals from disposal site, exposure to public,
sensitivity towards environment, and cost of transportation, can be
noticed as other important drivers. However, quantity of waste for
disposal along with area covered by a disposal facility has been
observed as the most dependent criteria. Therefore, it can be
inferred from the above ISM digraph that the above mentioned six
drivers would be more significant in carrying out the further study
instead of considering all eight criteria. To calculate the importance
(weights) of these criteria fuzzy AHP method has been applied in
Fig. 3. The ISM digraph.
the present study.

4.2. Application of fuzzy AHP

Table 2
Structural self-interaction matrix (group decision making). The nine respondents from hospitals and healthcare waste
disposal facility have been asked to fill the questionnaire of pair-
C8 C7 C6 C5 C4 C3 C2 C1
wise comparison matrix among six criteria. Additionally, the
C1 X X X O X A V 1 weights of each criterion, in triangular fuzzy numbers, have been
C2 A O O V V A 1 e
calculated using equation (12). Forman and Peniwati (1998)studied
C3 A V O V O 1 e e
C4 A V V A 1 e e e that in aggregating the responses of individuals the geometric
C5 A V X 1 e e e e mean of the responses of individual respondents could be more
C6 A A 1 e e e e e consistent in comparison to arithmetic mean; therefore, for
C7 A 1 e e e e e e computing the fuzzy weights of each criterion, the geometric mean
C8 1 e e e e e e e
of the responses has been calculated and used in the present study.
 A. Chauhan, A. Singh / Journal of Cleaner Production 139 (2016) 1001e1010 1007

IVthrespectively. The criteria mentioned in cluster IInd, IIIrd, and

8 C8
IVthshow the high dependence-low driving power, high
7
dependence-high driving power, and low dependence-high driving
6 Cluster-IV Cluster-III C1 power. Therefore, the criterion C6 and C7, which has high depen-
5 C3 dence and low driving power, has not been considered important
Driv 4 C4, C5 for facility location decision and eliminated thereafter.
ing 3 C2 C6, C7 The importance (weights) of six criteria i.e. C1, C2, C3, C4, C5,
pow 2 Cluster-I Cluster-II and C8 has been calculated with the help of fuzzy AHP method. The
er 1 combined fuzzy weights of the six criteria have been shown in
1 2 3 4 5 6 Table 5. These fuzzy weights have been used to compute the
Dependence Power weighted fuzzy normalized matrix in Table 7. The criteria weights
help in identifying the best alternative among the given seven al-
Cluster I- Autonomous driver
ternatives of facility location. The relative closeness, given in
Cluster II- Dependent driver
Cluster III- Linkage driver Table 11, of a criterion has been used to rank the seven healthcare
Cluster IV- Independent driver waste disposal facility locations. The relative closeness has been
calculated from negative ideal solution distance (d) where farther
Fig. 4. Driving and dependent Power diagram. the better principle has been applied. On the basis of the mentioned
principle L5 with 0.689 units distance has been ranked first
whereas L7 with 0.254 has been ranked seventh (last).
The weight of each criterion, in fuzzy numbers, has been given in
Table 5.
6. Conclusion

4.3. Application of fuzzy TOPSIS
The fuzzy TOPSIS method has been applied to capture the re-
sponses from each respondent in linguistic terms, as given in
Appendix A. The fuzzy responses obtained from medical superin-
tendents of hospitals and outsourcing firm management, along with
the weights obtained from fuzzy AHP, have been mentioned in Table 6.
Table 7 details about the fuzzy weighted normalized matrix. Table 8
shows the positive ideal solution (PIS) and negative ideal solution
(NIS) in view of the cost and benefit criteria. In this problem, distance
(C1), exposure (C2), and cost (C4) have been noticed as cost criteria,
whereas, availability of landfilling space (C3), sensitivity towards
environment (C5) and road condition (C8) have been considered as
benefit criteria. Furthermore, Tables 9 and 10 show the distances from
positive ideal solution (PIS) i.e. dþand negative ideal solution (NIS) i.e.
d, respectively. The rank of the alternative facility locations has been
mentioned on the basis of relative closeness from negative ideal so-
lution, calculated with the help of equation (26), as given in Table 11.
The de-fuzzification of the values mentioned in weighted
normalized matrix, Table 7, has been done with the help of the
formula given in eqn. (9).
5. Results and discussions
In the present study, ISM method has been applied to under-
stand the inter-relationships among the drivers and dependents
which have been shown with the help of a digraph in Fig. 3. Road
condition (C8) has been found as the most influencing driver which
drives the all other criteria. In contrast to this, area covered by a
HCW disposal facility (C6) and quantity of HCW received for
disposal (C7) has been noticed as the most dependent criteria.
MICMAC analysis in Fig. 4 shows that there are no criteria with
weak driving and weak dependence power i.e. Cluster I. However,
there are four, one and two criteria in cluster IInd, IIIrd, and
Table 5
Criteria weights in Fuzzy numbers.
C1 0.060 0.164
C2 0.125 0.304
C3 0.043 0.117
C4 0.033 0.087
C5 0.115 0.269
C8 0.028 0.058
The application of a hybrid multi-criteria decision making
method provides numerous benefits to decision makers such as fast
and effective decision making. The multi-criteria decision making
models provides less complex, more flexible and more practical
solutions, in the environment of multiple criteria (Beikkhakhian
et al., 2015a). In the present study, the ISM method has been
applied to eliminate the dependents which benefited the decision
makers in terms of time and complexity. Furthermore, the appli-
cation of fuzzy AHP method helped in calculating the weights of
each criterion in terms of triangular fuzzy numbers. Finally, the
ranking of alternative facility locations has been done with the help
of the fuzzy AHP weights and fuzzy TOPSIS. The location 5 has been
found as the best place for establishing a healthcare waste disposal
facility. Additionally, it has numerous benefits such as more dis-
tance, low public exposure, more land availability, less harmful for
environment, and better road condition. However, its cost is also
high but considering the fuzzy weights from Table 5, it can be
stated that the decision makers are more sensitive about other
criteria in comparison to lower cost which is usually observed in
conventional issues. The eight criteria identified from literature and
field survey may be noted as theoretical contribution of this study
along with the hybrid multi-criteria decision making method using
ISM, fuzzy AHP and fuzzy TOPSIS.
Since, the present study has been carried out to assist a
healthcare waste disposal firm's facility location decision; there-
fore, the findings of the study may play a significant role in its
decision making in future. The respondents of the present study
included the management of the healthcare waste disposal firm,
state pollution control board officers, and environmental re-
searchers. The inclusion of the expert respondents helped in the in-
depth understanding and gravity of the issue for the selection of a
sustainable location. The findings of the study have been discussed
with the practitioners including NGO's and general public. The
conversations with the people of the selected seven locations
looked promising for location 5, 4, 1, and 2; however, for other lo-
cations they opposed the establishment of healthcare waste
disposal facility. In contrast to this, the management of healthcare
waste disposal firm had issues with the selection of location 1, 4,
0.401
0.737 and 5; whereas, they agreed with location 2 and 3. The manage-
0.337 ment of HCW disposal firm appreciated the strength of this deci-
0.228 sion making process, because it included all stakeholders, and it
0.633 would help them in the selection of a sustainable location for
0.146
healthcare waste disposal facility.
1008 A. Chauhan, A. Singh / Journal of Cleaner Production 139 (2016) 1001e1010

Table 6
Fuzzy decision matrix for alternative facility locations.

C1 C2 C3 C4 C5 C8

L1 0.50 0.75 1.00 0.00 0.25 0.50 0.75 1.00 1.00 0.50 0.75 1.00 0.50 0.75 1.00 0.75 1.00 1.00
L2 0.25 0.50 0.75 0.25 0.50 0.75 0.50 0.75 1.00 0.75 1.00 1.00 0.50 0.75 1.00 0.25 0.50 0.75
L3 0.25 0.50 0.75 0.50 0.75 1.00 0.25 0.50 0.75 0.00 0.25 0.50 0.25 0.50 0.75 0.00 0.25 0.50
L4 0.75 1.00 1.00 0.00 0.25 0.50 0.00 0.00 0.25 0.00 0.00 0.25 0.75 1.00 1.00 0.75 1.00 1.00
L5 0.00 0.25 0.50 0.00 0.25 0.50 0.00 0.25 0.50 0.00 0.25 0.50 0.00 0.25 0.50 0.25 0.50 0.75
L6 0.50 0.75 1.00 0.25 0.50 0.75 0.25 0.50 0.75 0.25 0.50 0.75 0.50 0.75 1.00 0.25 0.50 0.75
L7 0.25 0.50 0.75 0.50 0.75 1.00 0.00 0.25 0.50 0.50 0.75 1.00 0.00 0.25 0.50 0.00 0.00 0.25

Fuzzy AHP weights 0.06 0.16 0.40 0.12 0.30 0.74 0.04 0.12 0.34 0.03 0.09 0.23 0.11 0.27 0.63 0.03 0.06 0.15

Table 7
Weighted normalized matrix for alternative facility locations.

C1 C2 C3 C4 C5 C8

L1 0.027 0.072 0.180 0.000 0.057 0.187 0.033 0.079 0.176 0.016 0.041 0.112 0.049 0.115 0.281 0.018 0.034 0.073
L2 0.013 0.048 0.135 0.039 0.113 0.281 0.022 0.059 0.176 0.023 0.055 0.112 0.049 0.115 0.281 0.006 0.017 0.055
L3 0.013 0.048 0.135 0.079 0.170 0.375 0.011 0.040 0.132 0.000 0.014 0.056 0.024 0.077 0.211 0.000 0.009 0.037
L4 0.040 0.096 0.180 0.000 0.057 0.187 0.000 0.000 0.044 0.000 0.000 0.028 0.073 0.154 0.281 0.018 0.034 0.073
L5 0.000 0.024 0.090 0.000 0.057 0.187 0.000 0.020 0.088 0.000 0.014 0.056 0.000 0.038 0.141 0.006 0.017 0.055
L6 0.027 0.072 0.180 0.039 0.113 0.281 0.011 0.040 0.132 0.008 0.028 0.084 0.049 0.115 0.281 0.006 0.017 0.055
L7 0.013 0.048 0.135 0.079 0.170 0.375 0.000 0.020 0.088 0.016 0.041 0.112 0.000 0.038 0.141 0.000 0.000 0.018

Table 8 Table 11
Positive and negative ideal solution table. Ranking of healthcare waste disposal facility locations.

C1 C2 C3 C4 C5 C8 Location d dþ RC ¼ d/(d þ dþ) Rank

L1 0.082 0.069 0.088 0.049 0.132 0.038 L1 0.134 0.171 0.562 2

L2 0.057 0.129 0.073 0.059 0.132 0.022 L2 0.152 0.130 0.462 4
L3 0.057 0.189 0.050 0.019 0.090 0.012 L3 0.173 0.085 0.330 6
L4 0.101 0.069 0.007 0.005 0.162 0.038 L4 0.157 0.177 0.530 3
L5 0.031 0.069 0.028 0.019 0.049 0.022 L5 0.045 0.147 0.766 1
L6 0.082 0.129 0.050 0.034 0.132 0.022 L6 0.151 0.117 0.436 5
L7 0.057 0.189 0.028 0.049 0.049 0.003 L7 0.164 0.050 0.232 7

PIS 0.031 0.069 0.088 0.005 0.162 0.038

NIS 0.101 0.189 0.007 0.059 0.049 0.003
the development of a hybrid multi-criteria decision making
method for the selection of a sustainable healthcare waste disposal
Table 9 facility. For practitioners such as healthcare waste disposal firms,
Distance from positive ideal solution (PIS). these criteria and hybrid method would help in the selection of an
economically, socially, and environmentally sustainable location.
C1 C2 C3 C4 C5 C8 dþ
This work would make an effective contribution towards the costly
L1 0.003 0.001 0.003 0.000 0.010 0.000 0.134
and thin profit making business of healthcare waste disposal.
L2 0.001 0.010 0.002 0.001 0.010 0.000 0.152
L3 0.001 0.025 0.000 0.000 0.004 0.000 0.173
Additionally, the safe, secure and clean environment for all living
L4 0.005 0.001 0.001 0.001 0.017 0.000 0.157 beings could be achieved with the help of this work.
L5 0.000 0.001 0.000 0.000 0.000 0.000 0.045
L6 0.003 0.010 0.000 0.000 0.010 0.000 0.151
L7 0.001 0.025 0.000 0.000 0.000 0.001 0.164
8. Limitations and future research directions

From researcher's view point, this work can be further

extended by using other multi-criteria decision making tech-
Table 10
niques such as DEMATEL. Furthermore, from practitioner's point
Distance from negative ideal solution (NIS).
of view, the management of HCW disposal firm revealed that the
C1 C2 C3 C4 C5 C8 d- future planning is another challenge in front of them, therefore,
L1 0.000 0.014 0.006 0.000 0.007 0.001 0.171 they described that they need a decision making model for ca-
L2 0.002 0.004 0.004 0.000 0.007 0.000 0.130 pacity planning including collection vehicles, number of in-
L3 0.002 0.000 0.002 0.002 0.002 0.000 0.085 cinerators, and labour, etc. However, there is no statistical
L4 0.000 0.014 0.000 0.003 0.013 0.001 0.177
validation of the results obtained from MCDM techniques; it can
L5 0.005 0.014 0.000 0.002 0.000 0.000 0.147
L6 0.000 0.004 0.002 0.001 0.007 0.000 0.117 only be verified with the help of domain experts (as we have done
L7 0.002 0.000 0.000 0.000 0.000 0.000 0.050 in this study).

7. Implications of the study
The literary contribution of this work can be stated as the
identification of criteria from literature review and field survey, and
Appendix A
Questionnaire survey: To understand the importance of each
criterion for healthcare waste disposal facility location problem.
 A. Chauhan, A. Singh / Journal of Cleaner Production 139 (2016) 1001e1010 1009

Linguistic variable Fuzzy number for AHP (fuzzy AHP) Fuzzy number for TOPSIS (fuzzy TOPSIS)

i to j response Inverse of number (j to i) i to j response

Very low (VL) (1, 1, 1) (1, 1, 1) (0, 0, 0.25)

Low (L) (1, 1, 3) (1/3, 1, 1) (0, 0.25, 0.50)
Medium (Equal) (M) (1, 3, 5) (1/5, 1/3, 1) (0.25, 0.50, 0.75)
High (H) (3, 5, 7) (1/7, 1/5, 1/3) (0.50, 0.75, 1)
Very High (VH) (5, 7, 9) (1/9, 1/7, 1/5) (0.75, 1, 1)

S.No. Criteria Description of criteria for HCWM

1 C1 Distance of waste disposal facility from hospitals/waste collection point

2 C2 The proximity of waste disposal site to population
3 C3 Availability of land for disposal (landfilling space) of healthcare waste
4 C4 Cost of transportation of HCW to disposal facility
5 C5 Sensitivity towards environment
6 C6 The weight or quantity of HCW for final disposal
7 C7 The area covered by a particular HCW disposal facility
8 C8 Road condition

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Ankur Chauhan is Doctoral student at Indian Institute of Management Rohtak, India.
He holds a M. Tech from National Institute of Technology, Jalandhar. His research in-
terest lies in various waste management areas such as solid waste, electronic waste,
and healthcare waste. Currently, he is carrying out his PhD thesis work in the area of
healthcare waste management. He has worked on research articles using multi-criteria
decision making techniques i.e. ISM, DEMATEL, AHP, ANP, and TOPSIS; He is also
comfortable with various statistical methods such as Regression, and ARIMA
modelling.
Dr. Amol Singh is a faculty in the Area of Operations at IIM Rohtak.He did his Ph.D. in
Industrial Engineering from IIT Roorkee in 2006, M. E. in Production Engineering from
MotiLal Nehru National Institute of Technology, Allahabad in 2000. His research area
includes various aspects of operations management such as project management,
supply chain management, etc. He has published several research papers in Interna-
tional Journals and conferences.