PONE-D-21-08622

Leadership development among public health officials in Nepal: A grounded theory

PLOS ONE

Dear Dr. Sudarshan Subedi,

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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Academic Editor

PLOS ONE

Editor Comments

The review process has some areas where your work can be improved. Please pay careful attention to each revision recommended. Please also seek professional assistance in respect to English gramma and spelling/ You may find it useful to seek the help of a professional editing service.

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2. In the Methods section, please consider including more information on the number of interviewers, their training and characteristics; and specify whether an interview guide was used to interview the participants in your study. Furthermore, please provide additional information regarding the interview guide development process, including the theories or frameworks which were employed. 

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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: Yes

Reviewer #3: Partly

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

Reviewer #1: N/A

Reviewer #2: I Don't Know

Reviewer #3: N/A

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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: Yes

Reviewer #2: Yes

Reviewer #3: 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

Reviewer #3: 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: Provide a definition of leadership upfront in the background

You mention that 'These officials are not formally employed as leaders but regularly exercise or enact leadership in their work. Stronger leadership in public health is needed to accelerate improvement in public health and this will happen when the public health practitioners have commitment and competencies to perform leadership...'

What are the actual gaps in their leadership? can you state these in that paragraph.

The rationale for leadership development is good

Were there any potential ethical issues with the focal person contacting the participants on behalf of the study team. Is it possible that some of the participants felt obliged to participate?

Please clarify what you mean by 'Exposure to incidental people during interviews was carefully handled.'

Results are well-presented

Were there any differences by gender or years of experience in the perspectives?

Good paper overall

Check for grammatical and typographical errors. For example, 'Literatures recommended' in abstract

Reviewer #2: The manuscript technically sound also data support the finding.

The analysis of the interview data were done in Nibali language which is good to reflect the real views of the participant but the authors must explain how do they translate those data or the codes to English? if they do so. I am satisfied with the writing fashion and English standard.

Reviewer #3: This is a qualitative study of leadership identity development in the Nepalese healthcare system. It brings interesting and well-coded information about how a representative and diverse group of managers have experienced coming into these roles, spanning castes, gender and professions. I am mmuch in favor of these kinds of studies and think this is very promising. However, I still do not think this study is finished in its present form. It is under-developed conceptually and the text suffers from it.

First of all, the focus and contribution is insufficiently conceptualized and not sufficiently grounded in literature. The study claims in the beginning and in the discussion section that a "gap" in the literature is identified, but I find this hard to follow in the present form. For example, a search in Web of Science using the two key words "leadership" and "healthcare" renders 8,800 publications. Adding "developing countries" as a key word, there are still 350 publications to review. The study needs a clearer focus and aim, relating the questions asked and the data collected to a more narrow set of research questions.

This unfortunate situation creates two quite strong flaws in the text. The first is that I, as a reader, am uncertain what the data actually represent. For example, are the stages of development that are presented something that were theoretically assumed a priori - a template to explore the subjects and their stories? Or were they derived from the interviews? I like to read the excerpts from the interviews but they do not inform a coherent set of research questions in my mind, and this is tricky for a scientific article. Another example is on page 28, which reads: "However, training and coaching were found to be negligible in developing leadership among public health officials in Nepal. Participants in this research had no or very minimal exposure to coursework and training related to leadership, consequently they emphasized more on 'learning by doing' or experience." I did not have the feeling that this was properly prepared and conceptualized prior to or during the interviews, and neither do I as a reader know what the subjects really said here. A stricter relationship between the questions and the results would be good.

The second becomes apparent in the discussion, where the text wanders a bit aimlessly about. For example, the role of genetic components in leadership talent is discussed but the study bears absolutely no data with relevance to this question. Such passages contribute to a feeling of lacking rigor in the conceptual foundation of the whole study.

In my opinion, the study would improve greatly by making more out of Nepal as a case in point for development of healthcare professionals as an important tool in the development of the services for the population. The lack of resources, the caste and gender issues, the groups of professionals and their relationships to their communities are important contexts to master for the system. I think that the authors do possess the necessary data to write an interesting study about nepalese healthcare officials but the present form is too narrow. I suggest that the authors reduce their ambitions to write something with general implications for leadership theories and maximize their focus on the local and developmental challenges, along with the practical consequences that follow for the professionals themselves and the authorities that employ them.

Finally, the text suffers from typos, incomplete sentences and ambiguous language. I think the authors should hve the manuscript proofread, possibly by a professional agency.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Jan Ketil Arnulf

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Leadership development among public health officials in Nepal: A grounded theory

PONE-D-21-08622R1

Dear Dr. Sudarshan Subedi,

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

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: 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 #1: Yes

Reviewer #3: Yes

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

Reviewer #1: N/A

Reviewer #3: N/A

**********

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 #3: No

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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 #1: Yes

Reviewer #3: Yes

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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: All my previous comments have been addressed satisfactorily. The authors could however, do a language sweep to address any minor grammatical and typographical errors.

Reviewer #3: I find the revised version of this manuscript much improved. It as addressed all the comments from the reviewers in a way that is mostly satisfactory. Given that the research question now is stated as "how does someone become a leader in public health in the context of Nepal", I believe that the results and the discussion sections are appropriate treatments of this. The present text is an explorative documentation of how individuals develop their public health leadership meeting resource shortages, caste system and gender inequality. In my opinion, this merits publication. I still think that the authors could have made their case and relevance even a bit stronger by outlining the situation for the Nepalese public health system. There seem to be some assumptions in the text building on tacit knowledge about the state of public health in Nepal, and the challenges facing a developing country with a population that has needs on many levels. This study brings out some of the mechanisms here, such as the sense of value-based engagement and the need to develop informal influential capabilities. The non-Nepalese reader would probably find a short description of the present-day challenges interesting to understand the full impact of the journey these public health leaders are making, and it might improve the future value of the article. However I leave it to the authors whether they would want to make some amendments in this direction or whether they think the present form of the article is sufficient for their aims.

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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 #1: No

Reviewer #3: Yes: Jan Ketil Arnulf