SMART Multi-Criteria Decision Analysis (MCDA)—One of the Keys to Future Pandemic Strategies

<b>Background/Objectives:</b> The COVID-19 pandemic underscored the need for adaptive public health strategies and effective decision-making tools to optimize clinical responses and policy measures based on regional contexts. This study aims to identify key criteria for developing a patient-centered strategy to enhance the resilience of Romania's healthcare system during the pandemic. <b>Methods:</b> This research introduces a Multi-Criteria Decision Analysis (MCDA) model using the Simple Multiple Attribute Assessment Technique (SMART) to integrate quantitative and qualitative data, providing decision-makers with a structured tool for improving healthcare resilience. A survey of 412 Romanian healthcare professionals identified critical risks and opportunities. The study followed a two-phase approach: first, analyzing expert perceptions to determine key challenges; second, applying a mixed-methods evaluation to prioritize resilience-building strategies. <b>Results</b>: Four main challenges emerged: (1) healthcare workforce shortages causing excessive workload and stress, (2) poor communication and systemic inefficiencies limiting patient access, (3) weak crisis management due to delayed control measures, and (4) regulatory gaps leading to fragmented responses. Proposed solutions included workforce training, improved communication, telemedicine integration, increased financial support, and a unified legal framework. The SMART method facilitated the structured prioritization of these measures, with long-term system sustainability emerging as the most effective strategy for preventing future crises. <b>Conclusions:</b> This study demonstrates the value of integrating MCDA into healthcare decision-making, offering a scalable model for policymakers to enhance crisis response and resource allocation. By incorporating expert insights and patient needs, the proposed framework strengthens healthcare system preparedness, contributing to informed, patient-centered decision-making and long-term resilience. Ultimately, our findings not only contribute to the existing literature but may also open new directions to facilitate informed, patient-centered decision making, thereby strengthening the resilience of healthcare systems in crisis situations.