PONE-D-23-41748Implementing the Patient Partnership Approach to Quality Improvement of Care and Services: A Multiple Case Study ProtocolPLOS ONE

Dear Dr. Deslauriers,

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Academic Editor

PLOS ONE

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Additional Editor Comments:

The main contribution of this study shall be pointed out in the discussion.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Partly

Reviewer #2: Yes

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2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Partly

Reviewer #2: Yes

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: No

Reviewer #2: Yes

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4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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: 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 #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Review comment

This manuscript entitled “Implementing the Patient Partnership Approach to Quality Improvement of Care and Services: A Multiple Case Study Protocol” primarily aimed to present the protocol of a multiple case study that is being conducted to document how this approach was implemented in different large healthcare organizations in Quebec. There are still some problems that cannot up this study to a publishing level. Some suggestions are listed in the specific comments below.

Specific comments:

1. What is the relationship between the multiple case study protocol proposed by the authors and the “Framework for the partnership approach between patients, their families and health and social service stakeholders” published by Quebec’s Ministry of Health and Social Services? Please further emphasise.

2. Given the relevance to the framework, is the current protocol limited to implementation in Quebec? I would recommend that the authors clarify this further in the manuscript (e.g., in the discussion section).

3. “Twelve to 15 key respondents will be recruited for each case”, how was the number of subjects determined?

4. Please provide the full name of the abbreviations when they first appear in the manuscript, e.g., here: “non-participant observations of the meetings of the QI committee engaging PFPs and”. The abbreviation “PFP” is not reasonably defined.

5. “This study will provide a better understanding of how healthcare organizations…”, I would suggest that the authors further enhance the discussion in the abstract section as it is unclear and does not provide information on the significant advantages of the current multiple case study protocol.

6. The research objectives proposed by the authors seem to be overstated, for example, “Analyze the adoption, fidelity and penetration of implementation of the partnership approach in QI within healthcare organizations.”

7. In the methods section, lengthy explanations of some basic research concepts (e.g., “case studies” and “case”) are unnecessary; please simplify them further.

8. In the semi-structured individual interviews, what was the basis for developing the relevant questions in the interview guides?

9. “In addition, since the coding step will be performed mainly by the first student-researcher, bimonthly meetings will be held with the research team…”, please provide more details about the data analysis section, especially the steps involving data coding. How was it implemented?

10. In the rigorous design of the case study, “Its credibility will be strengthened by triangulating the data collection methods (interviews, observations, document analysis) and debriefing the members of the research team during data interpretation via bi-weekly meetings”, How can the credibility of this study be enhanced through “bi-weekly meetings”?

11. In the discussion section, the potential contribution on the project needs to be further strengthened.

Reviewer #2: Review comment

This manuscript entitled “Implementing the Patient Partnership Approach to Quality Improvement of Care and Services: A Multiple Case Study Protocol” primarily aimed to explore how the partnership approach with patients and families is implemented in Quebec's healthcare organizations, following the province's guidelines. The results of this study provide guidance for publilc health. While it is a very interesting topic. But I think this manuscript has a lot of flaws to fill in before it can be published in a journal. There are several questions should be addressed, which list below. I give a minor revision for this manuscript.

Specific comments

1. In the Summary part, "However, while this framework provides guidelines by describing each partner’s role and the ways in which patient and family partners should be engaged in QI processes, it remains unclear how these recommendations were actually used and implemented by different healthcare organizations." Could you elaborate on the specific gaps or uncertainties in the implementation of the guidelines within healthcare organizations that this study aims to explore?

2. "Patient-centered approaches have emerged in healthcare organizations seeking to move away from paternalistic approaches and encourage more active participation from patients, families, and communities as partners in the healthcare system." What are the theoretical frameworks or models that underpin the transition from paternalistic to patient-centered care in the context of QI processes, and how have these models been evaluated for effectiveness in previous studies?

3. "This qualitative multiple case study will be conducted in four large healthcare organizations in Quebec. Twelve to 15 key respondents will be recruited for each case." What criteria were used to select these healthcare organizations and respondents, and how do these criteria ensure a comprehensive understanding of the patient partnership approach across different organizational contexts?

4. "This study will provide a better understanding of how healthcare organizations successfully engage PFPs in QI processes in different organizational contexts..." Based on preliminary insights or existing literature, what are the anticipated challenges in engaging patient and family partners in QI processes, and how might this study's findings contribute to overcoming these challenges?

5. In the Introduction part, “These include strategic support, the presence of leaders, the presence of formal processes and financial resources.” Please add a reference to support this sentence.

6. “It helps establish the necessary infrastructure and promote a change in attitudes and culture to one that is favorable to patient engagement” Please provide a more detailed description of how to address barriers to patient participation, for example, How to Avoid" No Show" to Planned Appointments?

Musa, S., Al Baker, W., Al Muraikhi, H., Nazareno, D., Al Naama, A., & Dergaa, I. (2021). Wellness Program Within Primary Health Care: How to Avoid" No Show" to Planned Appointments? -A Patient-Centred Care Perspective. Physical Activity & Health (2515-2270), 5(1).

7. “For their part, the program departments are responsible for implementing the partnership approach in organizational and clinical practices, including QI.” The reviewer suggested that the author provide a more detailed description of the partnership approach.

8. In the Methods part, “It therefore lends itself well to the study of management practices designed to promote partnerships with patients and their families.” Please add a reference to support this sentence.

9. In the Conclusion part, Please show detailed findings about this manuscript as well as what are the contributions for future clinical or scientific research.

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Reviewer #1: No

Reviewer #2: Yes: Zixiang Gao

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Implementing the Patient Partnership Approach to Quality Improvement of Care and Services: A Multiple Case Study Protocol

PONE-D-23-41748R1

Dear Dr. Deslauriers,

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,

Yaodong Gu

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Well done!

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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 and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: After careful revision by the authors, this manuscript has been greatly improved and all issues have been addressed.

Reviewer #2: Thank you to the authors for their hard work. The reviewers believe that after detailed revisions, this study has reached the level required for publication.

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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 #2: Yes: Zixiang Gao

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