Study on Sustainable Development Oriented Community Public Hospital in China Based on Optimal Decision Making Model for Environment Renovation
Round 1
Reviewer 1 Report
Dear authors, thanks for submitting your manuscript. The paper aims to support the government and hospitals in making decisions by eliminating the blind spots in capital investment and benefit evaluation. The paper is well written, the methodology and data collection process are well explained. To increase the quality of the paper, the following recommendations are given:
- Literature review section is needed to show what is done on this subject, to select the methodology and to identify the gap in the existing literature that the study aims to fill,
- Tables 6 and 9, figures 1, 3, 4, 5 should be referred in the text,
- Discussion section should be added before conclusion section, it should provide a comparison of obtained results with previous results, identify and explain the differences,
- Conclusion section should be revised as it is not consistent with the main goal determined as "This paper aims to support the government and hospitals in making decisions by eliminating the blind spots in capital investment and benefit evaluation",
- In conclusion section please add the theoretical and practical implementations of obtained results, provide recommendations for future studies, explain the contribution to the literature.
Author Response
The main changes to the paper are as follows:
Based on the feedback from the reviewers, in addition to making overall adjustments and revisions to the English writing of the article, significant modifications have been made to the abstract, introduction, section 2.2 on setting initial design variables for environment renovation of community public hospital, section 3.1 on FDM results, section 4 on discussion, and section 5 on conclusions.
The specific changes made in response to the comments are as follows:
Response to Reviewer 1 Comments
Thanks for submitting your manuscript The paper aims to support the government and hospitals in making decisions by eliminating the blind spots in capital investment and benefit evaluation. The paper is well written, the methodology and data collection process are well explained. To increase the quality of the paper, the following recommendations are given:
Point 1: Literature review section is needed to show what is done on this subject. to select the methodology and to identify the gap in the existing literature that the study aims to fill.
Response 1: In the final part of the introduction section, we have emphasized the contribution of this paper to the research field of medical facilities, specifically in the study of small and medium-sized hospitals. We have used the ODM model as the main method for this study. Please refer to lines 94-105 for more details.
Point 2: Tables 6 and 9 figures 1, 3 4, 5 should be referred in the text.
Response 2: After modification, we have added relevant descriptive content in section 3.2 and also mentioned in the discussion. See lines 263-265, lines 442-455.
Point 3: Discussion section should be added before conclusion section, it should provide a comparison of obtained results with previous results, identify and explain the differences.
Response 3: In terms of the structure of the paper, the original discussion content, namely the analysis of different funding inputs and benefits, has been moved to result section 3.4 and placed after the overall improvement scores and cost estimates for specific transformation strategies. The new discussion section discusses the research and results of “healthcare outcomes” and “built environment design variables” compared to Roger Ulirich's two papers. Based on this, discusses what adjustments have been made and what conclusions have been drawn according to different national contexts. For details, please see lines 383-441.
Point 4: Conclusion section should be revised as it is not consistent with the main goal determined as "This paper aims to support the government and hospitals in making decisions by eliminating the blind spots in capital investment and benefit evaluation".
Response 4: The conclusions of the paper have been greatly modified, summarizing the results of each chapter of the paper, and step by step deriving the final key transformation design variables and corresponding specific transformation strategies, different cost inputs, and benefit evaluations through the ODM model experiment. For details, please see lines 465-503.
Point 5: In conclusion section please add the theoretical and practical implementations of obtained results, provide recommendations for future studies, explain the contribution to the literature.
Response 5: At the beginning of the conclusion section of the paper, it was added that this paper has contributed to the theoretical and practical research on environmental design in small and medium-sized hospitals. Suggestions for future research directions have been added at the end, which include conducting research on indoor environmental transformation in different types of small and medium-sized specialty hospitals and exploring the preferences for environmental design from the perspectives of both medical staff and patients in terms of gender, age composition, and other factors. For details, please see lines 457-464, lines 509-516.
Author Response File: 
Author Response.docx
Reviewer 2 Report
COVID19 has served to rethink architecture, housing, workplaces and hospitals. This article is very interesting because it relates architecture, health and habitability conditions, however, this reviewer is not sure that this topic is the subject of this journal.
In case the editors accept this topic, some improvements are proposed:
- Since 2020 much has been published on architecture and COVID19, it would be interesting to expand the state of the art. I suggest some references:
Confinement, Comfort and Health: Analysis of the Real Influence of Lockdown on University Students during the COVID-19 Pandemic. DOI: 10.3390/ijerph18115572
A Mixed Approach on Resilience of Spanish Dwellings and Households during COVID-19 Lockdown. DOI: 10.3390/su122310198
COVID-19 and overdose prevention: Challenges and opportunities for clinical practice in housing settings. DOI: 10.1016/j.jsat.2020.108153
- The objective of the article is not specifically detailed, this should be written more precisely.
- The abstract does not comply with the author guidelines of this journal.
- It is not appropriate to mix tables and images as in "Table 6". Authors should restructure it.
Author Response
The main changes to the paper are as follows:
Based on the feedback from the reviewers, in addition to making overall adjustments and revisions to the English writing of the article, significant modifications have been made to the abstract, introduction, section 2.2 on setting initial design variables for environment renovation of community public hospital, section 3.1 on FDM results, section 4 on discussion, and section 5 on conclusions.
The specific changes made in response to the comments are as follows:
Response to Reviewer 2 Comments
Point 1: COVID19 has served to rethink architecture, housing, workplaces and hospitals. This article isvery interesting because it relates architecture, health and habitability conditions. however. thisreviewer is not sure that this topic is the subiect of this journal.
Since 2020 much has been published on architecture and COVID19, it would be interesting to expand the state of the art. I suggest some references:
Confinement, Comfort and Health: Analysis of the Real Influence of Lockdown on University Students during the COVID-19 Pandemic. DOI: 10.3390/ijerph18115572
A Mixed Approach on Resilience of Spanish Dwellings and Households during COVID-19 Lockdown. DOI: 10.3390/su122310198
COVID-19 and overdose prevention: Challenges and opportunities for clinical practice in housing settings. DOI: 10.1016/j.jsat.2020.108153
Response 1: Firsty,In this study, we aimed to achieve sustainable development by extending the service life of small and medium-sized community hospitals through environment renovation. We have emphasized this in the final part of the introduction section. Please refer to line??? for details.
Secondly, As hospital construction is a lengthy process and the age structure and scale of the served population have changed, patient needs are no longer consistent with the current situation. This paper focuses on the environmental renovation of medical facilities. Although COVID-19 is one of the reasons behind the renovation, it is not the primary driver. Therefore, this paper is not exclusively dedicated to COVID-19-related environmental renovations. The aim of this paper is to support government and hospital decision-making by eliminating blind spots in funding investment and benefit evaluation through the creation of initial design variables for environment renovation of community public hospital, empirical research, and the use of the ODM model.
Point 2: The objective of the article is not specifically detailed, this should be written more precisely.
Response 2: Response 2: The abstract section of this paper has been revised to better explain the objectives of the study. Additionally, the final part of the introduction section emphasizes the contribution of this research to the field of medical facility studies, specifically in the context of small and medium-sized hospitals, and the use of the ODM model as the primary research method. Please refer to lines 11-30, lines 94-105.
Point 3: The abstract does not comply with the author guidelines of this journal.
Response 3: Changes have been made to the abstract, please refer to lines 11-30.
Point 4: It is not appropriate to mix tables and images as in "Table 6". Authors should restructure it.
Response 4: Formatting adjustments have been made to the table images in Table 10(6). Details can be found in line 308.
Author Response File: Author Response.docx
Reviewer 3 Report
Dear Authors,
Thank you for your research, the idea itself is very important and valuable, however, please kindly allow me to make a couple of comments that you might want to take into consideration.
* Extensive language editing is required, the sentences seem to stop abruptly without due cause and are often not linked to the following one, in several cases the sentence needs paraphrasing to be better understood. Also, there is a clear discrepancy in the tenses used throughout the research, (jumping from the past to the present and then to the past again.)
*Across the research, while some statements have abundant references, others are clear statements that need references.
* Evidence-based design has more than merely two studies, kindly research this again and add accordingly, and while the research refers to the works of Roger Ulrich, the name used in the paper itself is written incorrectly. On the other hand, Roger Ulrich himself alone has more than two studies on evidence-based design in hospital design.
*You might want to paraphrase the details of the experts that underwent the study, 2 architects, 2 hospital managers, and 1 from the governmental construction planning department, as well as add a section on why an expert group was invited to partake in this study.
* Throughout the research, the authors use the singular form "author, researcher,.....", although they are more than one
* When you mention repositioning in line 66, do you mean retrofitting in old hospitals or altogether internal and external orientation and redesign, as each of these would entail a difference in the questions and indicators used henceforth.
*Kindly clarify how the Delphi method unified the experts' opinions and the main differences between the 4 rounds as an example as this is a core component in the methodology section
*In the indicators section, there are several indicators that may fall under more than one category, how was this segregated and utilized in the calculations, (for example, window area ratio does not only affect stress but may in turn reduce infection, how was this dealt with)
*Why was the 20, 20, 60% rule used, it is also unclear what you used the cutoff of 5.96 for after it was reached.
*Although, the results section is better written than its previous counterparts, there is no cohesion between how each of the results fit into the study and how they come together to develop the overall input that will aid the ODM tool.
*As a whole, the idea of the research itself is important, however, the research needs modifications.
Author Response
The main changes to the paper are as follows:
Based on the feedback from the reviewers, in addition to making overall adjustments and revisions to the English writing of the article, significant modifications have been made to the abstract, introduction, section 2.2 on setting initial design variables for environment renovation of community public hospital, section 3.1 on FDM results, section 4 on discussion, and section 5 on conclusions.
The specific changes made in response to the comments are as follows:
Response to Reviewer 3 Comments
Thank you for your research, the idea itself is very important and valuable, however, please kindly allow me to make a couple of comments that you might want to take into consideration.
Point 1: Extensive language editing is required, the sentences seem to stop abruptly without due cause and are often not linked to the following one, in several cases the sentence needs paraphrasing to be better understood. Also, there is a clear discrepancy in the tenses used throughout the research, (jumping from the past to the present and then to the past again.)
Response 1: Thank you for your suggestion. Regarding your comment on English writing, we have employed a professional editing service to polish the paper's English writing.
Point 2: Across the research, while some statements have abundant references, others are clearstatements that need references.
Response 2: Some of the statements in this manuscript are based on a wealth of references, while others are based on the authors' thinking.
Point 3: Evidence-based design has more than merely two studies, kindly research this again and add accordingly, and while the research refers to the works of Roger Ulrich, the name used in the paper itself is written incorrectly. On the other hand, Roger Ulrich himself alone has more than two studies on evidence-based design in hospital design.
Response 3: The corresponding text only referred to Roger Ulrich's two papers on the classification of healthcare outcomes and the design variables of the built environment when creating the initial design variables for environmental renovation. However, this article focuses on the application of ODM model in community hospital environmental renovation, supporting government and hospital decisions by eliminating blind spots in investment and benefit evaluation, demonstrating its applicability through empirical evidence, and not involving evidence-based design.
Therefore, to better highlight the focus, the content about evidence-based design was deleted in section 2.2, where initial design variables for environment renovation of community public hospital were established. Instead, we detailed which parts of Roger Ulrich's research were referenced and compared this study's results with Roger Ulrich's research in section 4. We further discussed the adjustments made based on different national contexts and the conclusions drawn. Please refer to lines 134-150, lines 383-454 for details.
Point 4: You might want to paraphrase the details of the experts that underwent the study, 2 architects, 2 hospital managers, and 1 from the governmental construction planning department, as well as add a section on why an expert group was invited to partake in this study.
Response 4: This paper added a table to statistically describe the age, institution, position, and education of the invited experts, and added a description of the reasons for inviting the experts. Please refer to lines 145-150,line 153 and line224.
Point 5: Throughout the research, the authors use the singular form "author, researcher,.....", although they are more than one.
Response 5: Thank you for your suggestion, we have modified these words to plural form.
Point 6: When you mention repositioning in line 66, do you mean retrofitting in old hospitals or altogether internal and external orientation and redesign, as each of these would entail a difference in the questions and indicators used henceforth.
Response 6: This study focuses on the indoor and outdoor landscape renovation of community hospitals and has been emphasized in 2.2 section, the ?? line(66) has also been modified. Please refer to line 142, line 74(66).
Point 7: Kindly clarify how the Delphi method unified the experts' opinions and the main differences between the 4 rounds as an example as this is a core component in the methodology section.
Response 7: In Section 2.2, we provide a detailed description of the process used to establish the initial environmental renovation design variables, including the use of the Delphi method to unify expert opinions. We have also included information on the aspects that were deleted during the three draft revisions. These additions provide readers with a better understanding of the design variables generation process. For further details, please refer to lines 155-176.
Point 8: In the indicators section, there are several indicators that may fall under more than one category, how was this segregated and utilized in the calculations, (for example, window area ratio does not only affect stress but may in turn reduce infection, how was this dealt with).
Response 8: For the issue of “several indicators may fall under more than one category”, it has emerged during the Delphi process for experts used to compile the initial design variables. In the first round of revisions, many indicators frequently appeared across different categories, with some indicators having a high probability of repeated occurrence (up to 40%). Additionally, some indicators appeared up to six times, which could have confused experts. To address this issue, we simplified the number of indicators from 136 to 78 after receiving expert opinions. We ensured that each design variables appeared only once and was retained in its most influential category. This part of the content changed as the point 7 comment.
Point 9: Why was the 20, 20, 60% rule used, it is also unclear what you used the cutoff of 5.96 for after it was reached.
Response 9: We have made an addition to chapter 3.1, where we provide more detailed information about the FDM results. The new supplement explains the underlying principle of FDM, the calculation method used to measure the value of Gi, and also includes expert recommendations on assigning weights of 20% to CM, 20% to OM, and 60% to EM. Please refer to lines 196-215, lines 228-234 for details.
Point 10: Although, the results section is better written than its previous counterparts, there is no cohesion between how each of the results fit into the study and how they come together to develop the overall input that will aid the ODM tool.
Response 10: We have made significant revisions to the conclusion of the paper. We have summarized the results of each chapter and derived the final key renovation design variables and corresponding specific renovation strategies, different cost inputs, and benefit evaluations through ODM model experiments. Finally, we added recommendations for future research directions. Please refer to lines 455-514 for details.
Author Response File: Author Response.docx
Reviewer 4 Report
Dear Authors,
The article is written well. Some updates can further enhance the quality and readership. These are:
1. Title: Capitalize each word properly
2. Abstract: Continuous paragraph as per the guidelines
3. Which Sustainable Goals are targeted in this work.
4. (Error) Line 158: The investigate and survey began in in September 2022 and lasted for two months.
5. Doctors may be more adaptive (Line 201-203 is for the same), visitors are less adaptive, if visitor is patient than deviation will be higher due to his/her medical condition.
6. Ratio of Male-Female is also important to mention. Age groups as well. Additional information can be provided as supplementary data with this article. Conclusion section can be enhanced with more conclusive details and future scope.
Author Response
The main changes to the paper are as follows:
Based on the feedback from the reviewers, in addition to making overall adjustments and revisions to the English writing of the article, significant modifications have been made to the abstract, introduction, section 2.2 on setting initial design variables for environment renovation of community public hospital, section 3.1 on FDM results, section 4 on discussion, and section 5 on conclusions.
The specific changes made in response to the comments are as follows:
Response to Reviewer 4 Comments
Dear Authors,
The article is written well. Some updates can further enhance the quality and readership. These are:
Point 1: Title: Capitalize each word properly
Response 1: We have checked the title words based on the suggestions. See lines 2-4.
Point 2: Abstract: Continuous paragraph as per the guidelines.
Response 2: We have made changes to the abstract to help better understand the background, objectives, and methods of the paper. Please refer to lines 11-30 for details.
Point 3: Which Sustainable Goals are targeted in this work.
Response 3: In this study, we aimed to achieve sustainable development by extending the service life of small and medium-sized community hospitals through environment renovation. We have emphasized this in the final part of the introduction section. Please refer to lines 94-105 for details.
Point 4: (Error) Line 158: The investigate and survey began in in September 2022 and lasted for two months.
Response 4: Thank you for your comment. We have corrected the errors in the sentences. Please refer to line192 (158) for details.
Point 5: Doctors may be more adaptive (Line 201-203 is for the same), visitors are less adaptive, if visitor is patient than deviation will be higher due to his/her medical condition.
Response 5: Thank you for your comment. We have added supplementary explanations in the results section of the I-S model (3.2) regarding the comparison between the importance-satisfaction scores of medical staff and patients and the reasons for their differences. Please refer to lines 22262-264, lines 296-297 for details.
Point 6: Ratio of Male-Female is also important to mention. Age groups as well. Additional information can be provided as supplementary data with this article. Conclusion section can be enhanced with more conclusive details and future scope.
Response 6: We have added information about gender ratio and age group in the first paragraph of the results section of the I-S model (3.2). However, due to the large differences between healthcare providers and users and the insufficient sample size for a quantitative discussion of environmental design preferences, we have included this as a future research topic in the concluding section. Additionally, we have added future research directions for the design of small and medium-sized specialty hospitals. Please refer to lines 248-250, lines 507-514 for details.
Author Response File: Author Response.docx
Round 2
Reviewer 1 Report
Thanks for revising the paper. The quality of the paper improved greatly.
Author Response
Dear Reviewer,
Thank you for your comments. Your comments have made our manuscript more comprehensive. In this revision, some improvements have been made to the manuscript including English editing.
Kind regards,
Authors
Reviewer 3 Report
Dear Authors,
Thank you very much for this well-revised manuscript. I have one final comment
In paragraph two of the research framework of section 2, you state:
"Through the expert Delphi method, experts such as the government, architects, and hospital management were consulted to jointly modify and form a set of initial design variables for the environmental renovation of community hospitals. After that, this paper used the optimal decision-making model (ODM) for reference, and DS community hospitals to be transformed were selected as experimental objects."
Kindly add what DS stands for between brackets.
Other than that
Good Luck!
Author Response
Response to Reviewer 3 Comments
Point 1: In paragraph two of the research framework of section 2, you state:
"Through the expert Delphi method, experts such as the government, architects, and hospital management were consulted to jointly modify and form a set of initial design variables for the environmental renovation of community hospitals. After that, this paper used the optimal decision-making model (ODM) for reference, and DS community hospitals to be transformed were selected as experimental objects."
Kindly add what DS stands for between brackets.
Response 1: Thank you for your comment. The modifications have been made, please refer to line120. In addition, some improvements have been made to the manuscript including English editing.
