A Two-Stage Fuzzy Decision-Support Framework for Assessing Pre-Construction Readiness of Healthcare Building Projects

Decisions made during the pre-construction phase play a decisive role in the success of healthcare building projects. Although pre-construction critical success factors (CSFs) have received considerable research attention, few studies have transformed CSF-based expert ratings into a quantitative and interpretable performance index. This paper develops and applies a two-stage Mamdani Fuzzy Inference System (FIS) to assess pre-construction performance in healthcare building projects. Data were collected using an online survey completed by construction professionals experienced in healthcare projects. After excluding incomplete responses, careless responses, and multivariate outliers, 201 valid responses were retained. A total of 54 CSFs grouped into eight pre-construction domains were assessed on a five-point Likert scale. The Relative Importance Index (RII) values were calculated and utilized as fuzzy rule weights. In Stage A, CSF-level ratings were converted into eight group-level performance scores, and in Stage B, these scores were integrated to form a single Pre-Construction Healthcare Project Performance Index (PCHPPI). The model was developed in MATLAB R2025b and used five triangular membership functions. The results showed that the scores at group level varied from 63.9% for Technology and Digital Integration to 66.7% for Procurement Planning. The overall PCHPPI was 62.7%, classified as High. Sensitivity analysis was performed using alternate weightings, membership function settings, defuzzification techniques and ±5% input variations. The PCHPPI was classified as High in all examined situations, indicating that it is relatively robust to modest variations in model assumptions and input conditions. This indicates that healthcare pre-construction performance is generally satisfactory but remains closer to the lower boundary of the High classification, suggesting room for improvement. The PCHPPI and Performance Octagon provide a structured basis for performance assessment, diagnosis, and potential benchmarking across pre-construction domains, providing a practical assessment instrument for healthcare construction organizations and project teams. The proposed framework provides a structured decision-support approach for project readiness evaluation during the early planning of healthcare building projects.