To be honest, too often, we perform a risk assessment not to make decisions but to justify an already existing risk assessment. The risk assessment may help define a few additional action items and determine how rigorous to be about a few things. It actually didn’t make much of an impact on the already-decided path forward. This is some pretty bad risk management and decision-making.

For highly important decisions with high uncertainty or complexity, it is useful to consider the options/alternatives that exist and assess the benefits and risks of each before deciding on a path forward. Thoroughly identifying options/alternatives and assessing the benefits and risks of each can help the decision-making process and ultimately reduce risk.

An effective, highly structured decision-making process can help answer the question, ‘How can we compare the consequences of the various options before deciding?

The most challenging risk decisions are characterized by having several different, important things to consider in an environment where there are often multiple stakeholders and, often, multiple decision-makers. 

In Multi-Criteria Decision-Making (MCDM), the primary objective is the structured consideration of the available alternatives (options) for achieving the objectives in order to make the most informed decision, leading to the best outcome.

In a Quality Risk Management context, the decision-making concerns making informed decisions in the face of uncertainty about risks related to the quality (and/or availability) of medicines.

Key Concepts of MCDM

1. Conflicting Criteria: MCDM deals with situations where criteria conflict. For example, when purchasing a car, one might need to balance cost, comfort, safety, and fuel economy, which often do not align perfectly.
2. Explicit Evaluation: Unlike intuitive decision-making, MCDM involves a structured approach to explicitly evaluate multiple criteria, which is crucial when the stakes are high, such as deciding whether to build additional manufacturing capacity for a product under development.
3. Types of Problems:

• Multiple-Criteria Evaluation Problems: These involve a finite number of alternatives known at the beginning. The goal is to find the best alternative or a set of good alternatives based on their performance across multiple criteria.
• Multiple-Criteria Design Problems: In these problems, alternatives are not explicitly known and must be found by solving a mathematical model. The number of alternatives can be very large, often exponentially.

Preference Information: The methods used in MCDM often require preference information from decision-makers (DMs) to differentiate between solutions. This can be done at various stages of the decision-making process, such as prior articulation of preferences, which transforms the problem into a single-criterion problem.

MCDM focuses on risk and uncertainty by explicitly weighing criteria and trade-offs between them. Multi-criteria decision-making (MCDM) differs from traditional decision-making methods in several key ways:

1. Explicit Consideration of Multiple Criteria: Traditional decision-making often focuses on a single criterion like cost or profit. MCDM explicitly considers multiple criteria simultaneously, which may be conflicting, such as cost, quality, safety, and environmental impact[1]. This allows for a more comprehensive evaluation of alternatives.
2. Structured Approach: MCDM provides a structured framework for evaluating alternatives against multiple criteria rather than relying solely on intuition or experience. It involves techniques like weighting criteria, scoring alternatives, and aggregating scores to rank or choose the best option.
3. Transparency and Consistency: MCDM methods aim to make decision-making more transparent, consistent, and less susceptible to individual biases. The criteria, weights, and evaluation process are explicitly defined, allowing for better justification and reproducibility of decisions.
4. Quantitative Analysis: Many MCDM methods employ quantitative techniques, such as mathematical models, optimization algorithms, and decision support systems. This enables a more rigorous and analytical approach compared to traditional qualitative methods.
5. Handling Complexity: MCDM is particularly useful for complex decision problems involving many alternatives, conflicting objectives, and multiple stakeholders. Traditional methods may struggle to handle such complexity effectively.
6. Stakeholder Involvement: Some MCDM methods, like the Analytic Hierarchy Process (AHP), facilitate the involvement of multiple stakeholders and the incorporation of their preferences and judgments. This can lead to more inclusive and accepted decisions.
7. Trade-off Analysis: MCDM techniques often involve analyzing trade-offs between criteria, helping decision-makers understand the implications of prioritizing certain criteria over others. This can lead to more informed and balanced decisions.

While traditional decision-making methods rely heavily on experience, intuition, and qualitative assessments, MCDM provides a more structured, analytical, and comprehensive approach, particularly in complex situations with conflicting criteria.

Multi-Criteria Decision-Making (MCDM) is typically performed following these steps:

1. Define the Decision Problem: Clearly state the problem or decision to be made, identify the stakeholders involved, and determine the desired outcome or objective.
2. Establish Criteria: Identify the relevant criteria that will be used to evaluate the alternatives. These criteria should be measurable, independent, and aligned with the objectives. Involve stakeholders in selecting and validating the criteria.
3. Generate Alternatives: Develop a comprehensive list of potential alternatives or options that could solve the problem. Use techniques like brainstorming, benchmarking, or scenario analysis to generate diverse alternatives.
4. Gather Performance Data: Assess how each alternative performs against each criterion. This may involve quantitative data, expert judgments, or qualitative assessments.
5. Assign Criteria Weights: By assigning weights, determine each criterion’s relative importance or priority. This can be done through methods like pairwise comparisons, swing weighting, or direct rating. Stakeholder input is crucial here.
6. Apply MCDM Method: Choose an appropriate MCDM technique based on the problem’s nature and the available data. Some popular methods include: Analytic Hierarchy Process (AHP); Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS); ELimination and Choice Expressing REality (ELECTRE); Preference Ranking Organization METHod for Enrichment of Evaluations (PROMETHEE); and, Multi-Attribute Utility Theory (MAUT).
7. Evaluate and Rank Alternatives: Apply the chosen MCDM method to evaluate and rank the alternatives based on their performance against the weighted criteria. This may involve mathematical models, software tools, or decision support systems.
8. Sensitivity Analysis: Perform sensitivity analysis to assess the robustness of the results and understand how changes in criteria weights or performance scores might affect the ranking or choice of alternatives.
9. Make the Decision: Based on the MCDM analysis, select the most preferred alternative or develop an action plan based on the ranking of alternatives. Involve stakeholders in the final decision-making process.
10. Monitor and Review: Implement the chosen alternative and monitor its performance. Review the decision periodically, and if necessary, repeat the MCDM process to adapt to changing circumstances or new information.

MCDM is an iterative process; stakeholder involvement, transparency, and clear communication are crucial. Additionally, the specific steps and techniques may vary depending on the problem’s complexity, the data’s availability, and the decision-maker’s preferences.

MCDM Technique	Description	Application	Key Features
Analytic Hierarchy Process (AHP)	A structured technique for organizing and analyzing complex decisions, using mathematics and psychology.	Widely used in business, government, and healthcare for prioritizing and decision-making.	Pairwise comparisons, consistency checks, and hierarchical structuring of criteria and alternatives.
Technique for Order Preference by Similarity to Ideal Solution (TOPSIS)	Based on the concept that the chosen alternative should have the shortest geometric distance from the positive ideal solution and the longest geometric distance from the negative ideal solution.	Frequently used in engineering, management, and human resource management for ranking and selection problems.	Compensatory aggregation, normalization of criteria, and calculation of geometric distances.
Elimination and Choice Expressing Reality (ELECTRE)	An outranking method that compares alternatives by considering both qualitative and quantitative criteria. It uses a pairwise comparison approach to eliminate less favorable alternatives.	Commonly used in project selection, resource allocation, and environmental management.	Use of concordance and discordance indices, handling of both qualitative and quantitative data, and ability to deal with incomplete rankings.
Preference Ranking Organization Method for Enrichment Evaluation (PROMETHEE)	An outranking method that uses preference functions to compare alternatives based on multiple criteria. It provides a complete ranking of alternatives.	Applied in various fields such as logistics, finance, and environmental management.	Preference functions, visual interactive modules (GAIA), and sensitivity analysis.
Multi-Attribute Utility Theory (MAUT)	Involves converting multiple criteria into a single utility function, which is then used to evaluate and rank alternatives. It takes into account the decision-maker’s risk preferences and uncertainties.	Used in complex decision-making scenarios involving risk and uncertainty, such as policy analysis and strategic planning.	Utility functions, probabilistic weights, and handling of uncertainty.