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The magnitude and global scale of this crisis provide a compelling incentive to thoroughly analyse its effects. This study aims to identify best practices within the Portuguese national healthcare service, with the goal of improving preparedness for future crises and informing policy decisions. Using a Benefit-of-the-Doubt (BoD) approach, this research constructs composite indicators to assess the pandemic's impact on the Portuguese public hospitals. The study analyzes monthly data from 2017 to May 2022, highlighting critical trends and performance fluctuations during this period. The findings reveal that each COVID-19 wave led to a decline in hospital performance, with the first wave being the most severe due to a lack of preparedness. Furthermore, the pandemic worsened the disparities among examined hospitals. Pre-pandemic top performers in each group improved their performance and were more consistently recognized as benchmarks, with their average benchmark frequency increasing from 66.5% to 83.5%. These top entities demonstrated greater resilience and adaptability, further distancing themselves from underperforming hospitals, which saw declines in both performance scores and benchmark frequency, widening the performance gap. The superior performance of top entities can be attributed to pre-existing strategic tools and contextual factors that enabled them to withstand the pandemic's challenges more effectively.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Highlights<\/jats:title>\n            <jats:p>\u2022 The pandemic aggravated the differences between the hospitals examined.<\/jats:p>\n            <jats:p>\u2022 The top-performing entities\u00a0further distanced themselves from\u00a0the remaining entities after the pandemic<\/jats:p>\n            <jats:p>\u2022 Entities considered benchmarks before the pandemic remained the same, and\u00a0became even more consistent during the pandemic.<\/jats:p>\n            <jats:p>\u2022 The top-performing entities achieved higher scores than their pre-pandemic performance levels.<\/jats:p>\n            <jats:p>\u2022 Benchmarking models for composite indicators with diverse decision-making preferences, and treatment of imperfect knowledge of data.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s10729-024-09693-4","type":"journal-article","created":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T03:48:19Z","timestamp":1732765699000},"page":"1-27","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Assessing the performance of Portuguese public hospitals before and during COVID-19 outbreak, with optimistic and pessimistic benchmarking approaches"],"prefix":"10.1007","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3742-2046","authenticated-orcid":false,"given":"Guilherme Mendes","family":"Vara","sequence":"first","affiliation":[]},{"given":"Marta Castilho","family":"Gomes","sequence":"additional","affiliation":[]},{"given":"Diogo Cunha","family":"Ferreira","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2024,11,28]]},"reference":[{"issue":"5\u20136","key":"9693_CR1","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1159\/000507423","volume":"64","author":"M Ciotti","year":"2019","unstructured":"Ciotti M, Angeletti S, Minieri M, Giovannetti M, Benvenuto D, Pascarella S, Ciccozzi M (2019) COVID-19 outbreak: an overview. 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