PONE-D-21-00656

What patients, healthcare workers, residents and students think about quality of care in an Italian academic hospital?

PLOS ONE

Dear Dr. Cecilia Smaniotto,

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.

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We look forward to receiving your revised manuscript.

Kind regards,

Sharon Mary Brownie

Academic Editor

PLOS ONE

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2. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information.

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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: No

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: No

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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: No

Reviewer #2: No

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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

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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: Thanks for the authors for the focus on quality of care, which I think is a bit neglected research area. The study definitely has a good merit.

Abstract

1. I didn't see and understand what the study design is

2. You mentioned the total questionnaires were 579/1,813, but, if you sum up the total, which is 165/772 HCWs, 111/355 residents, 121/389 students and 200/347 patients it gives 597/1863, can you explain that

Background

1. The background section is a little too much, although it is informative. I would subject narrowing it to less than 2 pages

Data analysis

1. You mentioned Ordered logistic regression were performed. Given that your outcome variable is ordinal it is the appropriate method. However, you didn't write about the assumptions that needs to be satisfied to proceed with ordered logit. The parallel lines assumption should be tested. If it fails, you should conduct generalized ordered logistic regression. This is quiet critical to make sure the results are valid.

Reviewer #2: A paper entitled “What patients, healthcare workers, residents, and students think about the quality of care in an Italian academic hospital?” is seeking to view the quality of care provided in X hospital by involving different stakeholders. Such articles have a good input towards the improvement of health care delivery. Here are some issues I encountered while reviewing the paper.

1. The title of the study is quite different from the body (main content).

2. Since the title is about perception, it is better if it had a qualitative method of data collection coupled with the qualitative one.

3. Line number 29, what is the need for the word “respectively”? What series was it represent?

4. Line number 29, the sum of subjects the study offered was 1863, not 1813 and also response collected was 597, not 579, according to your pieces of data.

5. Line number 113, the Main objective is totally different from the title of the study. The title states about the perception of overall quality of health care, whereas the main objective stated about the perception of different stakeholders towards the attendance of staff on training. The title seems a bit wide, it is better if modification is made based on the objective.

6. The main objective and the specific objective are not addressing well in the study.

7. Line number 141, inclusion criteria state that participants willing to participate in the survey were included whereas one criterion put in the exclusion criteria was a refusal to participate. Since study subjects refuse to can’t fulfill inclusion criteria consequently it cannot be an exclusion criterion.

8. The conclusion is not in accordance with the findings.

9. Line number 163, expected response rate 50%, if the non-respondent rate becomes as high as 50% it will not be representative of the population and also considering those non-respondent characteristics is also important for example if they are homogeneous in character it is difficult to exclude since they have something in common.

10. Line number 179-183, summation error noticed in the total study offered.

11. Line number 179, 1,813 subjects non-respondent rate were not mentioned how much was it?

12. The use of two words/phrases, “staff on training” vs “medical students and residents”, interchangeable are creating a little bit of confusion throughout the paper, better choose one.

Overall title, objective, and body of the manuscript lack coherence.

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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.

PONE-D-21-00656R1Does staff on training have an impact on quality of care? An assessment from different stakeholders in an Italian academic hospital, 2019.PLOS ONE

Dear Dr. Cecilia Smaniotto,

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 8 October. 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: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Sharon Mary Brownie

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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 #2: All comments have been addressed

Reviewer #3: All comments have been addressed

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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 #2: Yes

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

Reviewer #3: 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 #2: Yes

Reviewer #3: Yes

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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 #2: Yes

Reviewer #3: 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 #2: (No Response)

Reviewer #3: The authors have sufficiently addressed all the reviewers’ comments. However, the manuscript needs some minor revisions. First, in the result section, the authors should clearly highlight which results are referred to from the table 2. It is currently difficult to follow through the results on the table against the results in text. The authors should consider highlight the odds ratio / medians like in the abstract and refer to the table. Second, some typographical and grammatical errors should be corrected including the presentation on “n” in lines 185-193. Third, subtitles should be used in the method section (line 109-148) for better readability and clarity. Fourth, the authors should consider revising the title from "Does staff of training have an impact on quality of care?" to "Do medical students and residents impact the quality of patient care?". Similarly, the reference to "staff of training" should be revised to "medical students and residents" for clarity and readability.

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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 #2: No

Reviewer #3: 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.

Do medical students and residents impact the quality of patient care? An assessment from different stakeholders in an Italian academic hospital, 2019.

PONE-D-21-00656R2

Dear Dr. Cecilia Smaniotto,

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.

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Kind regards,

Sharon Mary Brownie

Academic Editor

PLOS ONE

Editor Comments 

Reviewer comments are satisfactorily addressed

Reviewers' comments: