Defining a positive work environment for hospital healthcare professionals: A Delphi study

Susanne M. Maassen; Catharina van Oostveen; Hester Vermeulen; Anne Marie Weggelaar

doi:10.1371/journal.pone.0247530

Peer Review History

Original SubmissionSeptember 18, 2020
22 Dec 2020 Decision Letter - Mohamad Alameddine, Editor PONE-D-20-29509 Defining a positive work environment for hospital healthcare professionals: a Delphi study PLOS ONE Dear Dr. Maassen, 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. Based on the recommendation of the reviewers, this manuscript is in a good shape to be accepted for publication pending some quick reviews for language, style and most importantly further elaboration on the methods especially the approach to reaching consensus using Delphi. 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Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. 3. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Additional Editor Comments (if provided): Based on the recommendation of the reviewers, this manuscript is in a good shape to be accepted for publication pending some quick reviews for language, journal style and most importantly further elaboration on the methods especially the approach to reaching consensus using Delphi. [Note: HTML markup is below. 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: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: N/A ****** 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: Yes ****** 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: I enjoyed reviewing this paper. I agree with the 3-round (versus only 2) for the Delphi study. The authors did a good job with the literature review, covering several databases and while not specifically a systematic review, did include additional references/concepts identified in the sample articles. I am curious about the positive WE dependent variable (for hospitals), as related to timeframes (years, decades, etc) - which may be different among countries, policies, and hospital regulations/etc. It is my opinion that the validity of the study was further increased by interviewing a variety of hospital industry professionals at different leadership/management/position levels. Most impressive is Table 4, as related/explained with the interview results at the end of the paper. Circling back to the task, social, cultural, and physical attributes (line 270) was also impressive. Limitations are valid points, yet not of concern to me in the end, beyond the locale/sampling bias mentioned. The paper does a good job reviewing hospital WE at an overall level and has spurred ideas for future, more specific research topics/questions. Reviewer #2: This article builds on previous a systematic review. The authors concluded the need for a standardized tool that could have been constructed based on their literature review Needs some editing to ensure coherence and perhaps more elaboration on the Methods especially the approach to reaching consensus using Delphi. ****** 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: No [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.0247530.r001
Revision 1
2 Feb 2021 Author Response Dear Professor Alameddine, We are pleased to learn that PLOS ONE is interested in publishing our paper, “Defining a positive work environment for hospital healthcare professionals: a Delphi study”. We wish to thank you and both reviewers for your positive feedback and constructive suggestions to improve our manuscript. We have now revised our manuscript as suggested by the reviewers. Below, we provide a point-by-point reaction to the comments of each reviewer. Feedback academic editor Based on the recommendation of the reviewers, this manuscript is in a good shape to be accepted for publication pending some quick reviews for language, style and most importantly further elaboration on the methods especially the approach to reaching consensus using Delphi. We thank the academic editor for their positive reaction. A native-speaking English language editor has made stylistic changes to improve the clarity and readability of the text. However, this led to changes throughout the whole document and is visible in the track change version of the manuscript. In addition, we have adapted the paper so it conforms to the style requirements of PLOS ONE. We acknowledge the editor and reviewer’s point concerning the approach to consensus in our Delphi study. We have responded to this issue in detail in our response to reviewer 2. Feedback reviewer 1 I enjoyed reviewing this paper. We thank reviewer 1 for the positive reaction and compliments. I agree with the 3-round (versus only 2) for the Delphi study. We thank reviewer 1 for this feedback and support for our choice of a three round Delphi design. The authors did a good job with the literature review, covering several databases and while not specifically a systematic review, did include additional references/concepts identified in the sample articles. I am curious about the positive WE dependent variable (for hospitals), as related to timeframes (years, decades, etc) - which may be different among countries, policies, and hospital regulations/etc. This literature review was published separately [1]. In this review, we screened 37 papers on development and psychometric validation of work environment measurement tools. We also elaborated on the differences in time frames and countries. We specifically looked for instruments that measure hospital employees’ experiences of WE in the broadest sense because employees nowadays work together in interdisciplinary teams. However, in the literature and in practice, we noticed that certain aspects of WE require more attention from nurses than doctors or vice versa. In the Delphi paper, we refer to this publication in the Methods section, but not in the Results because only the results of the present study should be described in this section. To clarify this point, we have modified line 175 (in the previous version line 182) and have added the reference. It is my opinion that the validity of the study was further increased by interviewing a variety of hospital industry professionals at different leadership/management/position levels. Most impressive is Table 4, as related/explained with the interview results at the end of the paper. Circling back to the task, social, cultural, and physical attributes (line 270) was also impressive. Limitations are valid points, yet not of concern to me in the end, beyond the locale/sampling bias mentioned. The paper does a good job reviewing hospital WE at an overall level and has spurred ideas for future, more specific research topics/questions. We thank the reviewer for these compliments and positive feedback. We acknowledge that there is local/sampling bias. Unfortunately, hospital facilities are not the same all over the world, just as employee facilities. This will most likely lead to differences in the perception of the work environment. Because of these differences, we chose to delineate a specific selection. This made it possible to set up a practice-orientated study with input from hospital employees. The results are recognizable and applicable in practice. However, our results may not be generalizable to hospitals all over the world. Feedback reviewer 2 This article builds on previous a systematic review. The authors concluded the need for a standardized tool that could have been constructed based on their literature review Needs some editing to ensure coherence and perhaps more elaboration on the Methods especially the approach to reaching consensus using Delphi. We thank reviewer 2 for the positive reaction and constructive feedback. We have addressed the coherence issues in cooperation with our native-speaking English language editor. Stylistic changes have been made throughout to improve the clarity and readability of the text. In this Delphi study, we defined consensus as the percentage agreement with the statement ‘element belongs to a positive WE’. Delphi participants were asked to rate, on a 10-point scale (where 1 = ‘not at all’ and 10 = ‘totally’), to which extent an element belonged to the concept of positive WE. We chose a 10-point rating scale because this is a well-known rating scale for most Delphi participants and is commonly used in Delphi studies. Lange et al (2020) described a large variety in rating scales applied in Delphi studies [2]. There is no consensus on which type of rating scale is preferable. Lange et al. (2020) stated that the research question and context of each study determines which rating scale is suitable [2]. In our population, scores between 8 and 10 were considered ‘good’, scores between 5 and 7 ‘adequate’, and scores of 4 or lower ‘bad’. We counted the frequency of each rating on the 10-point scale, then applied two thresholds. For rounds 1 and 2, we set the threshold for inclusion at 80%, indicating that >80% of participants rated the element eight or higher. For round 3, we set the threshold at 70%, indicating that >70% of respondents rated the element as 8 or higher. We acknowledge that a 10-point rating scale may have led to some bias due to variation in interpretation by the participants. Nevertheless, for our context and research sample, we consider this the best option. We have added this point to the limitations section in line 305-308: ‘fourth, the use of a 10-point rating scale may have led to some bias due to the risk of variation in interpretation by the participants. Nevertheless, we consider this 10-point rating scale as the best option for our context and research sample.’ The consensus method is described in the ‘data collection’ and ‘data analysis and consensus’ sections. We have now referred the reader to the ‘data analysis and consensus’ section in line 154-156: ‘in the second round, all elements with consensus in the first round following the forward set threshold (see section ‘Data analysis & consensus’ for consensus method and thresholds).’ We also defended our choice of a 10-point rating scale in lines 151–153: ‘the 10-point rating scale is a commonly known rating scale for the Delphi participants and widely used in Delphi studies. A score of eight, nine or ten was considered as agreement.’ We hope that, with these revisions, you will now find our manuscript suitable for publication in PLOS ONE. Sincerely, on behalf of all co-authors, Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0247530.r002
9 Feb 2021 Decision Letter - Mohamad Alameddine, Editor Defining a positive work environment for hospital healthcare professionals: a Delphi study PONE-D-20-29509R1 Dear Dr. Maassen, 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. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. 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. Kind regards, Mohamad Alameddine, MPH, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): We thank the authors for addressing the comments made by the editor and reviewers. We have no additional comments. Reviewers' comments: https://doi.org/10.1371/journal.pone.0247530.r003
Formally Accepted
15 Feb 2021 Acceptance Letter - Mohamad Alameddine, Editor PONE-D-20-29509R1 Defining a positive work environment for hospital healthcare professionals: a Delphi study Dear Dr. Maassen: 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 Dr. Mohamad Alameddine Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0247530.r004

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