Research on the Planning and Design of Med–Small-Sized Hospitals in China Based on Patient Perceived Value in the Context of Healthcare Model Transformation
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsREVIEW
on article
Establishing SEM of Patient Perceived Value for Med-small Sized Hospitals in China: Exploring the Relationship Between Patient Loyalty and Functional-and-Environmental design
Yunhui Zhu, Ying Zhou
SUMMARY
This paper establishes a patient perceived value model for medium- and small-sized hospitals in China. The relationship between patient loyalty and functional-ecological design was studied. The research problem stems from the fact that, in China, medium- and small-sized hospitals are responsible for providing basic medical care. However, their role has not yet been fully realized as people prefer large hospitals.
The authors identified perceived value factors based on patient satisfaction and loyalty to hospital facilities with the goal of increasing the public's willingness to visit medium- and small-sized hospitals by improving the functional planning and environmental design of hospitals.
The authors derived a model of the relationship between perceived value, patient satisfaction, and loyalty. The ideas they obtained can be applied in optimization for functional planning and environmental design of medium- and small-sized hospitals in China.
The reviewer believes that the authors have done interesting work, but there are significant doubts about the relevance of the topic of this article to the focus of the Buildings journal. The reviewer believes that the submitted article cannot be published in Buildings due to its inappropriate topic.
Moreover, this article has serious shortcomings that do not yet allow, in principle, to consider this article for publication in a high-ranking journal on the MDPI platform. The reviewer has reviewed this article and would like to make some recommendations to the authors in the hope that this will help improve this article and also wish the authors success in finalizing it for subsequent submission to another journal close to the social sciences.
COMMENTS
1. The first note is the presence of the abbreviation “SEM” in the title of the article. This abbreviation is not generally known. It can have different definitions. Authors are advised to replace this abbreviation with the full wording in the title of the article.
2. The abstract also contains shortcomings. There is no formulation of the scientific problem. There is an applied problem, but this is not enough for publication in a scientific journal. The research gap in this direction needs to be reported.
3. The “Introduction” section is presented very briefly and does not contain a complete analysis of the current state of the problem. It will be necessary to finalize this section and more clearly formulate the scientific and applied problems from the analysis.
4. The methods are described in detail, but there is no mention of the materials used in the section title. However, the authors used real cases from hospital practice in China. Therefore, a separate paragraph needs to be highlighted. "Materials for research."
5. The absence of a “Results” paragraph is unclear. This is unacceptable. Authors need to highlight their results clearly and then provide a separate discussion of them.
6. Conclusions need to be specified. Now they look like reasoning. Conclusions should be concise and clearly reflect the scientific novelty, practical significance, prospects for the development of this research in the future, as well as recommendations for real institutions.
7. You should also pay attention to the list of references used. It is not detailed enough for world-class research. The authors need to increase the number of sources from 36 to at least 50-55. Then this number will more closely indicate the problem at the moment.
Overall, as already stated, the reviewer does not consider it possible to publish this article in its current form, and also believes that it is not suitable for the journal Buildings. Nevertheless, the reviewer thanks the authors for their interesting work and wishes them success in finalizing this article based on the comments made, as well as in future scientific works.
Comments on the Quality of English LanguageModerate editing of English language required.
Author Response
The main changes to the paper are as follows:
The content of the article has been significantly modified and supplemented, the number of words has been increased from the original 6500 words to 9632 words, and the number of sections has been increased from 5 to 6 sections. All the sections have undergone a major overhaul.
The specific changes made in response to the comments are as follows:
Response to Reviewer 1 Comments
Point 1: The first note is the presence of the abbreviation “SEM” in the title of the article. This abbreviation is not generally known. It can have different definitions. Authors are advised to replace this abbreviation with the full wording in the title of the article.
Response 1: The title of the article has been replaced for brevity.Please refer to lines 3-4.
Point 2: The abstract also contains shortcomings. There is no formulation of the scientific problem. There is an applied problem, but this is not enough for publication in a scientific journal. The research gap in this direction needs to be reported.
Response 2: The abstract has been revised to highlight the scientific problem that the paper aims to solve, which adjustments need to be made in the planning and design of med-small sized hospitals (20-299 beds) in China to respond to healthcare transformation. The solution is to establish a patient perceived value model of med-small sized hospitals to understand the value orientation of patients. In the practical application, combining with the survry findings in Nanjing, this paper proposed the future planning and design optimization direction and strategies of med-small sized hospitals. Details can be found in line 9-25.
Point 3: The “Introduction” section is presented very briefly and does not contain a complete analysis of the current state of the problem. It will be necessary to finalize this section and more clearly formulate the scientific and applied problems from the analysis.
Response 3: The introduction part has been expanded to supplement the research background, that is, due to the changes in population structure and disease spectrum, China's healthcare is undergoing a transformation from traditional therapeutic medical care to life support healthcare, and there is still a gap in the research of med-small sized hospitals.
The explanations of scientific and applied problems are also added in the introduction section. Please refer to lines 29-165.
Point 4: The methods are described in detail, but there is no mention of the materials used in the section title. However, the authors used real cases from hospital practice in China. Therefore, a separate paragraph needs to be highlighted. "Materials for research."
Response 4: The content of " Materials for research " has been added to the third section of the research design, supplemented the explanation of the healthcare situation in Nanjing, China. And explained the selection logic of the type and number of the research hospitals: referring to the type and number ratio of med-small sized hospitals in Nanjing. Details can be found in line 268-284.
Point 5: The absence of a “Results” paragraph is unclear. This is unacceptable. Authors need to highlight their results clearly and then provide a separate discussion of them.
Response 5: The “Results”section has been added, and the model results are highlighted: 1.
Functional and cognitive values have the greatest impact on patient satisfaction and loyalty.
Among cost value, functional value, social value, and cognitive value, functional and cognitive value have the greatest impact on patient satisfaction and loyalty; 2. patients’ willingness to go to the inpatient department is quite low. Please refer to lines 366-371.
Each of these results is then discussed separately in the discussion section. Details can be found in line 468-532.
Point 6: Conclusions need to be specified. Now they look like reasoning. Conclusions should be concise and clearly reflect the scientific novelty, practical significance, prospects for the development of this research in the future, as well as recommendations for real institutions.
Response 6: The conclusions have been rewritten as requested. Please refer to lines 552-557.
Point 7: You should also pay attention to the list of references used. It is not detailed enough for world-class research. The authors need to increase the number of sources from 36 to at least 50-55. Then this number will more closely indicate the problem at the moment.
Response 7: The content of the paper has been supplemented, and the number of references has been increased to 59. Please refer to lines 587-719.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsAs China becomes an ageing society and the disease spectrum changes, exploring the relationship between patient loyalty and functional and environmental design based on patient perceived value in med-small sized hospitals is of interest. In this study, 600 relevant patients were interviewed by visiting eight specialist hospitals and seven community hospitals. The hypothesised model of patient perceived value in small and medium sized hospitals was developed and tested using structural equation modelling (SEM), which explains the relationship between patient perceived value and satisfaction and loyalty, and proposes corresponding optimisation suggestions, providing a new perspective for understanding patient behaviour. This paper should be improved before publication.
1. The background of the study is presented in some detail, but the theoretical foundation and literature review sections are weak, and the perceived value theory and its development process can be introduced in depth as appropriate.
2. This study was conducted only in Nanjing, and there may be differences in the healthcare environment, culture and patient preferences in different regions, which may affect the general applicability of the results. This study should be expanded to include hospitals in different regions and at different levels of development.
3. This study involved a large number of hospitals and respondents, but the number of questionnaires returned and valid questionnaires is still limited in comparison. The number and diversity of respondents should be increased to ensure that the sample is representative of the wider patient population.
4. The study has roughly modelled the hypotheses based on simple logic, and details of how the research hypotheses were identified should be presented, it is the basis of the study.
5. Convergent validity and discriminant validity are more important indicators in SEM, but they were not addressed in the study, so it is recommended to increase the calculation of convergent validity and discriminant validity to improve the reliability of the study.
6. The article briefly describes the modification of the model, and it is suggested that the modification and adjustment process of the initial hypothesis model should be described in detail for the readers' understanding.
7. The study did not fully consider the impact of different age groups of patients on the functional planning configuration. It is recommended that the study of the difference in impact between elderly and non-elderly patients be added, in line with the context of an ageing society.
Comments on the Quality of English LanguageThe English language should be improved.
Author Response
The main changes to the paper are as follows:
The content of the article has been significantly modified and supplemented, the number of words has been increased from the original 6500 words to 9632 words, and the number of sections has been increased from 5 to 6 sections. All the chapters have undergone a major overhaul.
The specific changes made in response to the comments are as follows:
Response to Reviewer 2 Comments
Point 1: The theoretical foundation part is weak, and the theory of perceived value can be introduced in-depth as appropriate.
Response 1: The content related to perceived value has been supplemented：the development process of the theory of perceived value has been supplemented in the “Introduction”. Please refer to lines 109-131.
In addition, the definition of the perceived value of the hospital is added in the “Model construction and research hypothesis”. Please refer to lines 202-213.
Point 2: The study was conducted only in Nanjing, and the healthcare environment, culture and patient preferences may differ in different regions, which may affect the general applicability of the results. The study should be expanded to include hospitals in different regions and at different levels of development.
Response 2: Due to the limitation of funds, transportation and time, Nanjing was selected as the research site for this study. As the capital city of Jiangsu Province, Nanjing’s healthcare resource situation can, to some extent, represent the healthcare level of strong second-tier cities in China. Furthermore, based on the author’s previous research experience, since most med-small sized hospitals in China are non-profit hospitals, they face many common issues, which lends a degree of universality to the research findings. These instructions are supplemented in the “Materials for research”. Details can be found in line 269-278.
Point 3: The study involved a certain number of hospitals and respondents, but the number of valid questionnaires is still limited. The number and diversity of respondents should be increased to ensure that the sample is representative of the wider patient population.
Response 3: According to the research of many literatures related to structural equation models, the sample size of 300 is suitable. Too large sample size will make it difficult to control the experimental conditions, and will also make the results contain more confounding factors and some unnecessary details, which will have a certain impact on the results.
Point 4: The study has roughly modelled the hypotheses based on simple logic, and details of how the research hypotheses were identified should be presented, it is the basis of the study.
Response 4: The relevant content has been supplemented. This paper uses literature research to select 5 initial perceived values to create hypothesis model. Please refer to lines 189-201.
And adopts the method of expert group meeting to determine 37 observed variables. Details can be found in line 236-246.
Point 5: Convergent validity and discriminant validity are more important indicators in SEM, but they were not addressed in the study, so it is recommended to increase the calculation of convergent validity and discriminant validity to improve the reliability of the study.
Response 5: Convergent validity and discriminant validity for SEM have been added. Please refer to lines 352-360 and line 364 for “Table 8. discriminant validity text”.
Point 6: The article briefly describes the modification of the model, and it is suggested that the modification and adjustment process of the initial hypothesis model should be described in detail for the readers' understanding.
Response 6: The research framework has been added to the section of “Research design”, which details the experimental steps of this study and adds related diagrams to help readers intuitively understand the adjustment and modification process from the hypothetical model to the final model. Details can be found in line 248-266.
Point 7: The study did not adequately consider the impact of different age groups of patients on the configuration of functional planning. It is recommended that more research is done on the impact of older versus non-elderly patients.
Response 7: Considering the limitation of the length of the paper, this paper mainly solves the problem of the value orientation of patients to med-small sized hospitals in China. Thank you very much for your valuable suggestions. In the next study, the author will conduct investigation, statistics and analysis on the differences of the user groups, especially patients of different ages, such as elderly patients and non-elderly patients. Please refer to lines 563-566.
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for Authors- Similar research is abundant. The authors failed to provide the novelty and urgency of this study.
- The authors need to state whether it was SEM-PLS or SEM-CB
- Citations are needed for indicators used.
- How and why ... from Figure 2 to Figure 3 are not explained well.
- The discussion section is also not well explained.
Comments on the Quality of English Language-
Author Response
The main changes to the paper are as follows:
The content of the article has been significantly modified and supplemented, the number of words has been increased from the original 6500 words to 9632 words, and the number of sections has been increased from 5 to 6 sections. All the chapters have undergone a major overhaul.
The specific changes made in response to the comments are as follows:
Response to Reviewer 3 Comments
Point 1: Similar research is abundant. The authors failed to provide the novelty and urgency of this study.
Response 1: Due to the changes in population structure and disease spectrum, China's healthcare is undergoing a transformation from traditional therapeutic medical care to life support healthcare. The adjustments need to be made in the planning and design of med-small sized hospitals (20-299 beds) in China to respond to healthcare transformation. But there is still a gap in the research of med-small sized hospitals. So this paper establish a patient perceived value model to understand the value orientation of patients. In the practical application, combining with the survey findings in Nanjing, this paper proposed the future planning and design optimization direction and strategies of med-small sized hospitals. Details can be found in line 9-25, 139-165.
Point 2: The authors need to state whether it was SEM-PLS or SEM-CB.
Response 2: The purpose of this study is to confirm and test the hypothesized model of patient perceived value in med-small sized hospitals, analyze the relationships between measurement variables and observed variables, as well as the relationships among the observed variables. In addition, there are sufficient samples (300), so the SEM-CB model testing method was employed. Details can be found in line 173-180.
Point 3: Citations are needed for indicators used.
Response 3: The reference literature for selecting patient perceived value has been added in " Definition of the dimensions of perceived value ". Please refer to lines 191-197.
Point 4: How and why ... from Figure 2 to Figure 3 are not explained well.
Response 4: Figure 3(original Figure 2) is the initial model established by AMOS26.0 after processing the questionnaire date, while Figure 4 (original Figure 3) is a revision of the initial model after pass the goodness-of-fit test, convergent validity and discriminant validity test. Details can be found in line 344-360.
Point 5: The discussion section is also not well explained.
Response 5: The discussion part has been supplemented and modified. On the one hand, the differences with the previous research results are explained. On the other hand, the model results are elaborated and optimized according to the survey findings in Nanjing. Please refer to lines 432-532.
Author Response File: Author Response.pdf
Reviewer 4 Report
Comments and Suggestions for AuthorsThis is a very interesting manuscript that deals with a current and important issue. The manuscript presents a study on perceived patient value for med-small hospitals (20-299 beds) in China. Considering that these hospitals are neglected while larger hospitals are overcrowded, the research presented aims to find out the factors of perceived value that influence patients' satisfaction and loyalty towards hospital facilities, with the aim of increasing the public's willingness to visit med-small sized hospitals by improving hospital functional planning and environmental design.
The summary is well written and contains all the important information about the research and the main findings. The introduction sets out the background to the research, the research problem and the literature review. The methods section is detailed and well written, and the presentation of the research results is clear and concise. The manuscript ends with conclusions that highlight the limitations of the research.
I have only a few comments:
(1) Please correct the way references are displayed in lines 82, 84 and 97.
(2) Under Methods, in lines 128-130, you have indicated how 37 observation variables were defined based on opinions of hospital management, medical staff and visitors, but you have not indicated when and how the study was conducted and how many respondents participated in the study. Can you please complete the methods with this data?
(3) I assume that "staff" should be written instead of the “stuff” in line 348 .
(4) Could you please indicate future research directions in the "Conclusions" section? Since this is an article in the field of architecture, it seems important to me that the four findings on optimizing the functional configuration and environmental design of med-small sized hospitals are also mentioned in the conclusion, perhaps in a slightly abbreviated form.
(5) Please indicate the year of publication of the book under reference number 27.
Author Response
The main changes to the paper are as follows:
The content of the article has been significantly modified and supplemented, the number of words has been increased from the original 6500 words to 9632 words, and the number of sections has been increased from 5 to 6 sections. All the chapters have undergone a major overhaul.
The specific changes made in response to the comments are as follows:
Response to Reviewer 4 Comments
Point 1: Please correct the way references are displayed in lines 82, 84 and 97.
Response 1: Thanks for your suggestion, we have checked the presentation of the references. After modification, the content has been removed.
Point 2: Under Methods, in lines 128-130, you have indicated how 37 observation variables were defined based on opinions of hospital management, medical staff and visitors, but you have not indicated when and how the study was conducted and how many respondents participated in the study. Can you please complete the methods with this data?
Response 2: In this study, 37 observational variables were identified through literature research and expert group meetings. Related content is added in “Research model and hypothesis”. Please refer to lines 236-246.
Point 3: I assume that "staff" should be written instead of the “stuff” in line 348 .
Response 3: Thanks for your suggestion, after modification, the content has been removed.
Point 4: Could you please indicate future research directions in the "Conclusions" section? Since this is an article in the field of architecture, it seems important to me that the four findings on optimizing the functional configuration and environmental design of med-small sized hospitals are also mentioned in the conclusion, perhaps in a slightly abbreviated form.
Response 4: In the conclusion part, the future research direction has been added, and the optimization suggestions on the planning and design of med-small sized hospitals have been added. Details can be found in line 543-551.
Point 5: Please indicate the year of publication of the book under reference number 27.
Response 5: Thanks for your suggestion, this reference has been deleted.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsThe article was significantly improved.
I recommend the article for publishing.
Author Response
Point 1: The article was significantly improved. I recommend the article for publishing.
Response 1: Thank you for your suggestion.
Author Response File: Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsThe clarity of the research framework diagram in Figure 2 needs to be optimised.
Author Response
Point 1: The clarity of the research framework diagram in Figure 2 needs to be optimised.
Response 1: The clarity of Figure 2 has been optimized. Please refer to line 211.
Author Response File: Author Response.pdf
Reviewer 4 Report
Comments and Suggestions for AuthorsThe authors have thoroughly revised the manuscript and thus considerably improved its quality. The work can be published.
Author Response
Point 1: The authors have thoroughly revised the manuscript and thus considerably improved its quality. The work can be published.
Response 1: Thank you for your suggestion. If you agree with the modification, please sign your review report.
Author Response File: Author Response.pdf
