The effect of Iran’s health transformation plan on hospital performance: Kerman province

Reza Goudarzi; Mohammad Tasavon Gholamhoseini; Somayeh Noori Hekmat; Setareh YousefZadeh; Saeed Amini

doi:10.1371/journal.pone.0247155

Peer Review History

Original SubmissionJune 18, 2020
3 Sep 2020 Decision Letter - Edris Hasanpoor, Editor PONE-D-20-18684 The effect of Iran's Health Transformation Plan on Hospital Performance Kerman Province PLOS ONE Dear Dr. Tasavon Gholamhoseini, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Oct 18 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: No ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: In the methods section, the authors mentioned that 19 selected hospitals are included in the study. What is the total number of the hospitals in the province? Is the 19 hospitals representative number or not? Results: There is no explanation why 1) the average efficiency was not significant. Can you explain this result in terms of the results of the table 1 which includes significant tests with p-value <0.05. Table 2 is not very clear. It does not include any significant results, that is technical efficiency has no significant change. Can you connect table 2 results with table 3? Is there statistical significant change of the Malmquist productivity index between years? In table 2, university hospitals efficiency is done with Paired t -test. The non university hospitals test is wilcoxon. When you test total hospitals you use Wilcoxon. Don't you think this is inconsistency? in the first case you have normality assumption and the other 2 categories you use non parametric test. Please explain!!! Reviewer #2: 1. The introduction section needs to be clarified for the readers for better understanding. There is need of more references so far decision making system is concerned. Literature are available in the context of global level in decision making. 2. In methodology the authors should explain the procedures in detail so that the study can be replicated elsewhere. for example DEA method needs more specification. Data analyse procedures also need details explanation. 3. In result table 1 is understandable But, table 2 and 3 need explanation and scientific interpretation of the results. there is also need of clarity do the understanding of the readers. 4. the discussion section needs complete overwhelming. Similar results are to be interpreted with study of more literature. Important results from the tables are still missing in discussion section ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes:** Ranjit Kumar Dehury [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0247155.r001
Revision 1
22 Oct 2020 Author Response Reviewer#1 1. In the methods section, the authors mentioned that 19 selected hospitals are included in the study. What is the total number of the hospitals in the province? Is the 19 hospitals representative number or not? Response: Thanks for your comment. In our revised version, we provide more detail about hospital data. A total of 24 hospitals were entered to study, 5 of which were excluded from the final analysis due to lack of sufficient data (Please see page 5, lines 86-89). 2. There is no explanation why 1) the average efficiency was not significant. Can you explain this result in terms of the results of the table 1 which includes significant tests with p-value <0.05. Response: Thanks for your comment. Although some variables changed significantly after HTP, the physician variable was not significant and thus the efficiency and productivity changes after HTP were not significant. We discuss this in the Discussion section of the revised manuscript (Please see pages 12 and 13, lines 216 and 240-242). We also performed a regression to find that the physician variable could be more important than the other variables( Please see the figure below). 3. Table 2 is not very clear. It does not include any significant results, that is technical efficiency has no significant change. Can you connect table 2 results with table 3? Is there statistical significant change of the Malmquist productivity index between years? Response: Thanks for your comment. We have changed the Table 2 as suggested by reviewer #1. Statistical tests were performed for productivity changes before and after HTP and were reported in Table 3. 4. In table 2, university hospitals efficiency is done with Paired t -test. The non university hospitals test is wilcoxon. When you test total hospitals you use Wilcoxon. Don't you think this is inconsistency? in the first case you have normality assumption and the other 2 categories you use non parametric test. Please explain!!! Response: Thanks for your comment. We first assessed the normality and abnormality of the statistical distribution of data in each scenario using the Kolmogorov – Smirnov test; then, we measured the efficiency and productivity changes by appropriate statistical tests ( Paired t-test or Wilcoxon). In this study, the efficiency data of university hospitals had a normal distribution, so we used the paired t-test to measure changes in efficiency before and after HTP. However, the efficiency data of non-university hospitals were abnormally distributed, and the Wilcoxon test was used. The efficiency data of all hospitals were also abnormally distributed. We have explained more in the revised version (Please see page 7, lines 130-136). Reviewer#2 1. The introduction section needs to be clarified for the readers for better understanding. There is need of more references so far decision making system is concerned. Literature are available in the context of global level in decision making. Response: Thanks for your comment. As suggested, we have added details on the importance of decision-making in the health system (Please see pages 3 and 4, lines 59-67). 2. In methodology the authors should explain the procedures in detail so that the study can be replicated elsewhere. for example DEA method needs more specification. Data analyse procedures also need details explanation. Response: Thanks for your comment. We have added more details in the revised version (Please see pages 5-7, lines 101-109 and 132-136). 3. In result table 1 is understandable But, table 2 and 3 need explanation and scientific interpretation of the results. there is also need of clarity do the understanding of the readers. Response: Thanks for your comment. We have changed Tables 2 and 3 as suggested by reviewer #2. 4. the discussion section needs complete overwhelming. Similar results are to be interpreted with study of more literature. Important results from the tables are still missing in discussion section Response: Thanks for your comment. As suggested, the discussion section is updated in the revised version of the paper. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0247155.r002
23 Dec 2020 Decision Letter - Sharon Mary Brownie, Editor PONE-D-20-18684R1 The effect of Iran's Health Transformation Plan on Hospital Performance Kerman Province PLOS ONE Dear Dr. Mohamad Tasavon Gholamhoseini, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by 25 January.. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Sharon Mary Brownie Academic Editor PLOS ONE Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: I think if you use graphical representation for the productivity (eg histograms or boxplots) before and after HTP, the readers would get better understanding of your variables. Can you report the standard error of the productivity numbers in table 3? This could tell us important information about the variability of productivity for the suggested 4 categories Reviewer #2: 1. The article need more discussion to make the study comparable with others. 2. the reference articles have to be from very high authoritative sources. New articles should be added in introduction section to make the technicalities understandable. 3. The tables especially paired test tables have to be explained for understanding. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes:** Ranjit Kumar Dehury [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0247155.r003
Revision 2
13 Jan 2021 Author Response Dear editor in chief Thank you for your invaluable comments and guidance in improving this manuscript. It should be noted that based on the Reviewer’s comments and according to Journal requirements, we made some changes in manuscripts that are specified in text. We presented the responses to reviewers’ comments separately in the following table. I as the corresponding author on behalf of all authors express our readiness to do any further revision seems necessary by the journal. Reviewer#1-1 : I think if you use graphical representation for the productivity (eg histograms or boxplots) before and after HTP, the readers would get better understanding of your variables. Response: Thanks for your comment. We added two figures in our revised version so that the reader can understand the changes in productivity and efficiency better (please see figures 1 and 2 and see page 11, lines 193-196). Reviewer #1-2: Can you report the standard error of the productivity numbers in table 3? This could tell us important information about the variability of productivity for the suggested 4 categories. Response : Thanks for your comment. We added standard errors of productivity numbers for different scenarios (please see table 3). Reviewer #2-1: The article need more discussion to make the study comparable with others. Response: Thanks for your comment. We added some studies to compare with the present study in the discussion section (please see page 12, lines 208-210 and page 13, lines 234-236). Reviewer #2-2: 2. the reference articles have to be from very high authoritative sources. New articles should be added in introduction section to make the technicalities understandable. Response: Thanks for your comment. We searched Scopus and Pubmed databases for the most recent studies related to this research, and two studies were added to the introduction section (please see page 4, lines 80-82). Reviewer #2-3: 3. The tables especially paired test tables have to be explained for understanding. Response: Thanks for your comment. We provided more details about statistical tests in our revised version (please see page 9, lines 181, 196, and page 10, line 197). Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0247155.r004
3 Feb 2021 Decision Letter - Sharon Mary Brownie, Editor The effect of Iran's Health Transformation Plan on Hospital Performance Kerman Province PONE-D-20-18684R2 Dear Dr. Mohamad Tasavon Gholamhoseini, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. 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If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Authors have addressed all the issues but they have not discussed the additional information (standard errors and the graphics) Reviewer #2: Comments have been addressed. But, more references can be discussed for improvement of the article. The language of the article can also be improved for the readers. The technical words should also be explained for betterment. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes:** RANJIT DEHURY https://doi.org/10.1371/journal.pone.0247155.r005
Formally Accepted
5 Feb 2021 Acceptance Letter - Sharon Mary Brownie, Editor PONE-D-20-18684R2 The effect of Iran's Health Transformation Plan on Hospital Performance: Kerman Province Dear Dr. Tasavon Gholamhoseini: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Professor Sharon Mary Brownie Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0247155.r006

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