PONE-D-24-51441Impact of Joint Commission International accreditation on occupational health and patient safety: A systematic reviewPLOS ONE

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This work was supported by the Orton Research Institute through grants from the Ministry of Social

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Additional Editor Comments:

The manuscript has a good deal of merit for publication after minor revisions

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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: Partly

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

Reviewer #1: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: Yes

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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

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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:  Thank you for the opportunity to review your manuscript entitled “Impact of Joint Commission International Accreditation on Occupational Health and Patient Safety: A Systematic Review”. The review contributes significantly by discussing how international accreditation affects important outcomes, including patient safety and occupational health (such as job satisfaction and productivity). A notable effort was made by the authors to highlight the gaps with regards to the impact of Joint Commission International (JCI) accreditation on these outcomes.

Following suggestions are offered to further enhance the quality, clarity, and coherence in the manuscript.

1. Short Title: The short title while informative does not explicitly reflect the study design. For greater clarity and precision, a revision is suggested, such as: “A Systematic Review on Joint Commission International Accreditation in Occupational Health and Patient Safety.” This concise title clearly conveys the scope of the study while ensuring that it is aligned with the systematic review design.

2. Abstract: The abstract would benefit from a clearer structure and greater coherence. Using subheadings such as Background, Methods, Results, and Conclusion is recommended. Additionally, the Methods section would include specific details regarding the study design, data sources, and inclusion/exclusion criteria.

3. Introduction:

a. Rephrasing and Redundancy: The sentence in lines 64-65 contains multiple instances of “and,” which disrupt the introductory flow. Simplifying this sentence would improve readability and coherence, particularly given its placement at the beginning of the paper.

b. Elaboration: Lines 81-82 note that smaller facilities incur higher costs, but the statement lacks sufficient explanation. Expanding on this observation with specific examples or references, such as “Mumford et al. found that smaller facilities in Australia incurred higher costs due to [specific reasons],” would enhance clarity and provide a more complete discussion.

4. Materials and Methods:

a. Title: It is suggested to consider renaming this section to “Methods” as the study does not include experiments or materials. This would better align with the study’s scope as a systematic review.

b. Language Restrictions: The statement in line 103, “No language restrictions were applied,” contradicts the exclusion of non-English publications mentioned later in lines 114-115. Clarification is necessary to ensure consistency in the description of inclusion criteria.

c. Criteria Justification: The rationale for selecting the National Heart, Lung, and Blood Institute’s quality assessment tool should be elaborated upon. For example providing information on why this specific tool was appropriate for evaluating the methodological quality of the included studies would strengthen the methodology section. Similarly, the classification criteria (good, fair, poor) should be clearly defined. Including a table summarizing the criteria before Table 1 would improve understanding and transparency.

d. Generalizability: Table 1 could be expanded to address how the included studies are representative of global impacts and their relation to targeted regions. Including regional percentages or distributions would add depth to the discussion and demonstrate the study's broader applicability.

5. Results:

a. Negative Effects: Lines 173-174 indicate that accreditation had a larger negative impact than positive but provide limited context. Expanding on this observation with examples and analysis would help clarify the implications and provide a more balanced view.

b. Rephrasing: Lines 213-215 contain a lengthy and complex sentence that could be simplified. For instance: “Higher ratings for quality improvement leadership directly relate to increased nurse-reported quality improvement activities and a greater perceived impact of computerization on care quality.” This version is more concise while retaining the original meaning.

c. Table 3 Formatting: Certain numerical and punctuation errors in Table 3 should be corrected for accuracy and consistency. Examples include “58,3%,” which should be changed to “58.3%,” and “US$ 593 000,” which should be revised to “US$ 593,000.”

6. Discussion:

a. Content Improvement: The discussion section tends to reiterate findings already presented in earlier sections. Instead, it could focus on identifying key research gaps and emphasizing how the study addresses those gaps. Highlighting the study’s implications for policy-making, future research directions, and societal benefits would significantly enhance the section.

b. Highlighting citations focusing on why patient safety is a crucial aspect in terms of cost effectiveness and improving the overall quality of life would strengthen the impact of international accreditation in healthcare services.

c. Separate Headings: Adding distinct sections for Limitations and Conclusion would improve the structure of the discussion. The Limitations section could detail the study’s shortcomings, such as the exclusion of non-English publications, while the Conclusion could emphasize the broader implications and potential applications of the findings. Highlighting how the study supports policy-making or practical improvements would underscore its relevance.

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Reviewer #1: No

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Impact of Joint Commission International accreditation on occupational health and patient safety: A systematic review

PONE-D-24-51441R1

Dear Dr. Anni Teija Orvokki Vuohijoki,

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.

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Kind regards,

Naeem Mubarak, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The manuscript has a good deal of merit for publication

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 #1: 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

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

Reviewer #1: Yes

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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

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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

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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: (No Response)

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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

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