Configurations associated with the efficiency of the ophthalmology departments in public hospitals of Central South China

Yimeng Li; Yao Chen; Bosheng Ma; Jyu-lin Chen; Jie Zhong; Yan Jiang; Jing Luo; Jia Guo

doi:10.1371/journal.pone.0315218

Peer Review History

Original SubmissionJuly 18, 2024
13 Nov 2024 Decision Letter - Andrzej Grzybowski, Editor PONE-D-24-25670Configurations associated with the efficiency of the ophthalmology departments in public hospitals of Central South ChinaPLOS ONE Dear Dr. Li, 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 Dec 28 2024 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. 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, Andrzej Grzybowski Academic Editor PLOS ONE Journal Requirements: 1. When submitting your revision, we need you to address these additional requirements. 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. Thank you for stating the following financial disclosure: [Central South University through its graduate innovative research grant (grant number: 2024ZZTS0998)]. Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. 3. In the online submission form, you indicated that [Data cannot be shared publicly because other studies using this data have not been fully completed. Data are available from the corresponding author upon reasonable request]. All PLOS journals now require all data underlying the findings described in their manuscript to be freely available to other researchers, either 1. In a public repository, 2. Within the manuscript itself, or 3. Uploaded as supplementary information. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If your data cannot be made publicly available for ethical or legal reasons (e.g., public availability would compromise patient privacy), please explain your reasons on resubmission and your exemption request will be escalated for approval. 4. 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. [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: Yes 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: 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: The paper addresses a relevant topic and aligns with the requirements and focus of the journal. What I appreciate the most is: Unique use of combined methods: The study combines Data Envelopment Analysis (DEA) and Fuzzy Set-Qualitative Comparative Analysis (fs-QCA), which is a relatively innovative approach to measuring the efficiency of healthcare facilities. DEA provides precise quantitative data on efficiency, while fs-QCA identifies specific configurations of variables that lead to high or low efficiency. This approach not only evaluates efficiency but also uncovers specific combinations of factors influencing it, which is uncommon in typical efficiency research. Overall, this research provides a new perspective on efficiency in ophthalmology, an innovative methodological approach, and practical recommendations that could be useful not only for the Chinese healthcare system but also for other developing countries facing similar challenges. Reviewer #2: Overall, I thought your article was well-written and provided sound analysis of the determinants of efficiency in ophthalmology departments. I appreciated your discussion of China's context for ophthalmological health as well as the policy implications of your fundings. As PLOS ONE is an interdisciplinary journal, some additional explanations of what is considered a "high", "low", or "adequate" number of resources/staff that you are measuring here would be helpful in assessing the impact of your results. I have provided some additional minor comments below. Line 23 - China is now classified as an upper-middle income country, not sure if it’s appropriate to call “a typical LMIC.” Line 242 - What does degree of membership to the outcome mean? This section could use more explanatory text. Line 253 - Why was the threshold 0.9? Is this standard practice in the literature? Lines 258-259 - Same as above, why were these values selected? Lines 338-341 - This sentence is confusingly worded. Suggest rephrasing “high levels of the number” to be “high numbers”; combine lines 340 & 341 into one sentence. Lines 343-345 - Same as above, change “high levels of the number” to “high numbers”. Please change in subsequent lines as well. Lines 380-384 - Please expand this section - did you perform a sensitivity analysis? The methods used to check robustness are not clear. A table would be helpful here as well. Lines 389-390 - Please change wording of “didn’t fully utilize their ophthalmology resources” to “had underutilized their ophthalmology resources”. Line 438 - Again, lower number of nurses or a lower number of open beds. Line 452 - Citation needed. Lines 472-473 - What is considered an adequate number? ****** 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.0315218.r001
Revision 1
20 Nov 2024 Author Response Dear Editors and Reviewers: Thank you for your letter and for the reviewers’ comments concerning our manuscript entitled “Configurations associated with the Efficiency of the Ophthalmology Departments in Public Hospitals of Central South China (PONE-D-24-25670)”. Those comments are all valuable and very helpful for revising and improving our paper. We have studied the comments carefully, and according to these comments and suggestions, we added new information to the revised manuscript to help clarify the content. The response to each comment and corresponding changes are listed as follows. ① The review’s comment: China is now classified as an upper-middle income country, not sure if it’s appropriate to call “a typical LMIC.” The authors’ answer: Thank you very much for your suggestions. We have reviewed the literature again and confirmed that, although China is currently an upper-middle-income country, its per capita ophthalmic resources are comparable to those of typical LMICs and fall short compared to other developed countries. Therefore, we revised the sentence to highlight the current state of ophthalmic resources in China, ensuring the text is more rigorous. Revised sentence: China has the largest population of eye diseases, affecting more than 59.28 million people [19]. The prevalence of moderate and severe vision impairment in China increased more rapidly than in the other G20 countries from 1990 to 2010[20]. However, although China has been classified as an upper-middle income country, the per-capital ophthalmology resources in China are the same as the LMICs [21], leading the current capacity of eye care services in public hospitals has failed to meet the growing demand for ophthalmology service [5]. (revised manuscript: lines 98-104) ② The review’s comment: What does degree of membership to the outcome mean? This section could use more explanatory text. The authors’ answer: Thank you for your valuable feedback. The degree of membership represents the extent to which a variable belongs to a specific outcome set. We have added an explanation of "the degree of membership" in line 247. Revised sentence: In the calibration process, the metrics of the full members, the cross-over point, and the full non-members were set as standards for determining the corresponding variables' relatively high, medium, and low levels and efficiency scores. The degree of membership, which indicated the degrees of the variables belonging to the levels, was also calculated to categorize each variable into relatively high, medium, and low levels. (revised manuscript: lines 219-224) ③ The review’s comment: Why was the threshold 0.9? Is this standard practice in the literature? Same as above, why were these values selected? The authors’ answer: Thank you for pointing out these problems. We have added the rationale and relevant citations for selecting these values in lines 257 and 264–265. Revised sentence: In the necessity test, we set the consistency threshold as 0.9, which was the recognized standard to ensure a consistent relationship between the configurations and the outcomes [39,41,42], to judge whether the variable was the necessary variable that could fully explain the resulting outcome. (revised manuscript: lines 256-260) The sufficient analysis would infer the configurations that lead to different efficiency levels. We set the minimum raw consistency value to 0.80 and the Proportional Reduction in Inconsistency (PRI) consistency values to 0.75 to ensure the sufficient relationship between the configurations and the outcomes according to the guidelines [38]. (revised manuscript: lines 231-240) ④ The review’s comment: This sentence is confusingly worded. Suggest rephrasing “high levels of the number” to be “high numbers”; combine lines 340 & 341 into one sentence. The authors’ answer: Thank you for your thorough review. Following your suggestion, we have revised "high levels of the number" to "high numbers." The sentence consolidation has also been revised accordingly, and the updated sentence can be found in lines 344–347. Revised sentence: Configuration HT3 and HT4 concluded that the second type of high-efficiency ophthalmology departments effectively combined a high number of ophthalmologists, equipment, and nurses, with a particular emphasis on the highest levels of ophthalmologists and equipment (revised manuscript: lines 320–323). ⑤ The review’s comment: Please change wording of “didn’t fully utilize their ophthalmology resources” to “had underutilized their ophthalmology resources”. The author's answer: Thank you for your suggestion. We have revised the sentence accordingly. Revised sentence: This study first examined the ophthalmology departments from an efficiency perspective and revealed that ophthalmology departments in both tertiary and secondary hospitals in Hunan Province of Central South China had underutilized their ophthalmology resources. (revised manuscript: lines 385-388). ⑥ The review’s comment: Again, lower number of nurses or a lower number of open beds. The authors’ answer: Thank you for your thorough review. Following your suggestion, we have revised "low levels of the number" to "low numbers." ⑦ The review’s comment: Please expand this section - did you perform a sensitivity analysis? The methods used to check robustness are not clear. A table would be helpful here as well. The authors’ answer: Thank you for your valuable feedback. Based on your suggestions, we have rewritten this section, adding relevant content to clarify this part more effectively. Additionally, we have included the table with the robustness test results in the manuscript. Revised sentence: Changing the consistency level was the guideline-recommended and most commonly used method to test the robustness of the fs-QCA results [39,43]. This study followed the method, changing the raw consistency level from 0.80 to 0.90 and 0.70 to conduct the robustness test. When the consistency level was 0.70, the solution results are in Table 8, and when the consistency level was 0.90, the solution results are in Table 9. The results had no substantial changes in the main findings, except for minor changes in the value of coverage and consistency, which indicated the relative robustness of the results of this study. (revised manuscript: lines 363-371). ⑧ The review’s comment: Citation needed. The authors’ answer: Thank you for your feedback. We have carefully reviewed the literature and added supporting references in the relevant part of this sentence. Revised sentence: This may be explained by the cooperation among ophthalmology departments in different hospitals [59]. (revised manuscript: lines 448-449) ⑨ The review’s comment: What is considered an adequate number? The authors’ answer: Thank you for your suggestion. We have rewritten this sentence to clarify that "adequate" refers to ensuring that the number of facilities and ophthalmologists can maintain the hospital's capacity for ophthalmic patients, even with a reduction in the number of beds. The specific revision can be found in lines 494–495. Revised sentence: Our findings also suggest that when reducing open beds to cut medical costs [28], ophthalmology departments should maintain adequate numbers of equipment and ophthalmologists to ensure the number of patients they can serve is not reduced due to fewer beds. (revised manuscript: lines 468-471). In addition to the above revisions, we have also updated the reference list by adding the following citations (as numbered in the revised manuscript). Apart from this, we have not removed or made any other changes to the references. [21] Resnikoff S, Lansingh VC, Washburn L, Felch W, Gauthier T-M, Taylor HR, et al. Estimated number of ophthalmologists worldwide (International Council of Ophthalmology update): will we meet the needs? Br J Ophthalmol. 2020;104: 588–592. doi:10.1136/bjophthalmol-2019-314336 [39] Schneider CQ, Wagemann C. Set-Theoretic Methods for the Social Sciences: A Guide to Qualitative Comparative Analysis. Cambridge: Cambridge University Press; 2012. doi:10.1017/CBO9781139004244 [41] Fiss PC. Building better causal theories: A fuzzy set approach to typologies in organizational research. Acad Manage J. 2011;54: 393–420. doi:10.5465/AMJ.2011.60263120 [42] Gupta K, Crilly D, Greckhamer T. Stakeholder engagement strategies, national institutions, and firm performance: A configurational perspective. Strateg Manag J. 2020;41: 1869–1900. doi:10.1002/smj.3204 [43] White L, Lockett A, Currie G, Hayton J. Hybrid Context, Management Practices and Organizational Performance: A Configurational Approach. J Manag Stud. 2021;58: 718–748. doi:10.1111/joms.12609 [59] Wang J, Ju R, Chen Y, Zhang L, Hu J, Wu Y, et al. Automated retinopathy of prematurity screening using deep neural networks. EBioMedicine. 2018;35: 361–368. doi:10.1016/j.ebiom.2018.08.033 We tried our best to improve the manuscript and made some changes marked in red in the revised paper, which will not influence the content and framework of the paper. We appreciate your warm work earnestly and hope the correction will meet with approval. Once again, thank you very much for your comments and suggestions. Sincerely, Jia Guo, PhD, RN, Professor (Corresponding author) Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, Hunan, PR China; 410013 E-mail: guojia621@163.com Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0315218.r002
22 Nov 2024 Decision Letter - Andrzej Grzybowski, Editor Configurations associated with the efficiency of the ophthalmology departments in public hospitals of Central South China PONE-D-24-25670R1 Dear Dr. Li, 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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, 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, Andrzej Grzybowski Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0315218.r003
Formally Accepted
27 Nov 2024 Acceptance Letter - Andrzej Grzybowski, Editor PONE-D-24-25670R1 PLOS ONE Dear Dr. Li, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, 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 customercare@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. Andrzej Grzybowski Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0315218.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .