Empirical Examination of the Interactions Between Healthcare Professionals and Patients Within Hospital Environments—A Pilot Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

It is a study on the impact of health workers' satisfaction on patients' satisfaction with two questionnaires on the perception of job satisfaction by professionals and on the experiences of hospitalized patients.

The introduction is concise and appropriate, objective is clear, materials and methods are described in detail, the results are interesting results even if predictable and the discussion is valid with conclusions supported by the results.

I suggest adding a paragraph on limitations and explaining better how the bidirectional causality problem between the 2 variables was solved.

Author Response

 Open Review 1

( ) I would not like to sign my review report
(x) I would like to sign my review report

Quality of English Language

( ) The English could be improved to more clearly express the research.
(x) The English is fine and does not require any improvement.

 

	Yes	Can be improved	Must be improved	Not applicable
Does the introduction provide sufficient background and include all relevant references?	(x)	( )	( )	( )
Is the research design appropriate?	( )	(x)	( )	( )
Are the methods adequately described?	(x)	( )	( )	( )
Are the results clearly presented?	(x)	( )	( )	( )
Are the conclusions supported by the results?	( )	(x)	( )	( )

Comments and Suggestions for Authors

It is a study on the impact of health workers' satisfaction on patients' satisfaction with two questionnaires on the perception of job satisfaction by professionals and on the experiences of hospitalized patients.

The introduction is concise and appropriate, objective is clear, materials and methods are described in detail, the results are interesting results even if predictable and the discussion is valid with conclusions supported by the results.

I suggest adding a paragraph on limitations and explaining better how the bidirectional causality problem between the 2 variables was solved.

Submission Date

28 March 2025

Date of this review

12 Apr 2025 07:10:08

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Responses to Review 1

The suggestions were followed, paragraph 5 was inserted with the title: Limitations and Future Research. Improvements were also made to the research design, conclusions (lines 555-570), and wording of the text to make it more accessible.

All upgrades are presented in the text in yellow for your convenience.

Thank you for your contribution to improving this research study.

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Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for the opportunity to read your manuscript.   Your work is interesting to me and will surely be interesting to other readers.

I have limited comments for you.  Please use them in the spirit in which they are provided.  Use what is helpful to you and to your message and ignore the rest.

I truly appreciate that you numbered the lines of your manuscript.  That makes communicating with one another so much easier.

Line 67:  It's either "in recent decades" or "in the past 10 years". I cannot tell which is your intent.

Line 246:  are we to assume that "middle-aged" means age 26-45 years?

Line 258:  With % that go to the hundredths space, I would expect the total to equal 100, but it doesn't 76.25 + 21.15 + 0.56 = 97.96 

Line 316 and beyond:  While the discussion of endogeneity is informative and correctly presented, I am having trouble seeing how you are certain that happy or contented providers are the cause of higher patient satisfaction, rather than happy or contented patients increasing provider satisfaction.  It is clear that your conclusion (see line 374) is that provider satisfaction must come 1st, but I'm struggling to see how this has been demonstrated.  

Line 443:  I do not know hat "a more closed knowledge" means

Impressive bibliography - thank you for these resources, in addition to your work.

Author Response

 

Open Review 2

( ) I would not like to sign my review report
(x) I would like to sign my review report

Quality of English Language

( ) The English could be improved to more clearly express the research.
(x) The English is fine and does not require any improvement.

 

	Yes	Can be improved	Must be improved	Not applicable
Does the introduction provide sufficient background and include all relevant references?	(x)	( )	( )	( )
Is the research design appropriate?	(x)	( )	( )	( )
Are the methods adequately described?	(x)	( )	( )	( )
Are the results clearly presented?	(x)	( )	( )	( )
Are the conclusions supported by the results?	(x)	( )	( )	( )

Comments and Suggestions for Authors

Thank you for the opportunity to read your manuscript.   Your work is interesting to me and will surely be interesting to other readers.

I have limited comments for you.  Please use them in the spirit in which they are provided.  Use what is helpful to you and to your message and ignore the rest.

I truly appreciate that you numbered the lines of your manuscript.  That makes communicating with one another so much easier.

Line 67:  It's either "in recent decades" or "in the past 10 years". I cannot tell which is your intent.

Line 246:  are we to assume that "middle-aged" means age 26-45 years?

Line 258:  With % that go to the hundredths space, I would expect the total to equal 100, but it doesn't 76.25 + 21.15 + 0.56 = 97.96 

Line 316 and beyond:  While the discussion of endogeneity is informative and correctly presented, I am having trouble seeing how you are certain that happy or contented providers are the cause of higher patient satisfaction, rather than happy or contented patients increasing provider satisfaction.  It is clear that your conclusion (see line 374) is that provider satisfaction must come 1st, but I'm struggling to see how this has been demonstrated.  

Line 443:  I do not know that "a more closed knowledge" means

Impressive bibliography - thank you for these resources, in addition to your work.

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Responses to Review 2

Line 67:  It's either "in recent decades" or "in the past 10 years". I cannot tell which is your intent.

• Response: The suggestion was followed, we wrote "in the past 10 years"

Line 246:  are we to assume that "middle-aged" means age 26-45 years?

• Response: The suggestion was followed, we wrote "(26-45 years)" in lines 256-257

Line 258:  With % that go to the hundredths space, I would expect the total to equal 100, but it doesn't 76.25 + 21.15 + 0.56 = 97.96 

• Response: The suggestion was followed, we had given a general picture of the patients' financial situation, we correct our sentence by giving all the details in lines 270-272, so our sentence is structured as follows:

“Financially, 76.25% of the patients described their situation as very difficult, whereas 21.15% stated they were managing but faced financial constraints, 1.37% indicated an inability to afford their expenses, only 0.56% reported having no financial issues, and 0.67% chose not to disclose information regarding their financial situation.”

Line 316 and beyond:  While the discussion of endogeneity is informative and correctly presented, I am having trouble seeing how you are certain that happy or contented providers are the cause of higher patient satisfaction, rather than happy or contented patients increasing provider satisfaction.  It is clear that your conclusion (see line 374) is that provider satisfaction must come 1st, but I'm struggling to see how this has been demonstrated.  

• It is clear from what you refer that you have understood the rationale behind our research effort. Regarding your concerns:

1. Theoretically our opinion is supported in lines 104-106 of section 2 entitled “Theoretical background and research hypotheses” where we refer that: “the emphasis is placed on the fact that if an organization cannot satisfy the needs of its employees, it will probably never be able to satisfy its patients.”
2. We understand that a stronger presentation of our conclusion is necessary and must supported by the results of our survey, as such we added the lines 555-570 “The results of our survey…in patient satisfaction”.

The suggestion was followed

Line 443:  I do not know that "a more closed knowledge" means

• Response: The suggestion was followed, we have reworded our proposal to make it more understandable, as such the sentence in lines 467-470, was formed as follows:

“2) have the opportunity to have a more closed knowledge regarding their health concerns, more specifically about the treatment protocols they will undergo, potential outcomes, side effects of treatments, and self-care strategies which will be followed,”

All upgrades are presented in the text in yellow for your convenience.

Thank you for your contribution to improving this research study.

-----------------------------------------------------------------------------------------------------------------------

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Authors,

Thank you for letting me read your manuscript. Your topic is timely and important, especially regarding the growing importance of human relationships in healthcare. Connecting the satisfaction of healthcare professionals and patients is commendable. Below, I’ve outlined my thoughts and suggestions section by section to hopefully help you strengthen your already important work.

1. Title & Abstract

Your title sets the tone for the article well and clearly communicates that this is a pilot study, which helps manage reader expectations. However, it might flow better as:

"An Empirical Examination of the Interaction Between Healthcare Professionals and Patients in Hospital Settings."

The abstract summarises your work well but could be clearer in some areas. For example, the sentence “At the cornerstone of medical lies in the relationship…” is a bit awkward and would benefit from smoother phrasing. Try something like:

"At the heart of effective healthcare is the relationship between physicians and patients."

You do a good job presenting your findings here, especially by including the quantified relationship between staff satisfaction and patient satisfaction, but a touch more detail on the methodology (especially the use of 2SLS regression) would help orient readers unfamiliar with the technique.

2. Introduction

The introduction is rich in detail and reflects a sincere effort to frame the issue within existing literature. You touch on job satisfaction, patient expectations, and systemic challenges — all highly relevant. However, it does get a bit dense and could benefit from a more narrative flow. Consider trimming some of the repetition and guiding the reader more smoothly from the general topic to your specific research questions.

I appreciated your emphasis on the Greek healthcare context — especially the dual pressure of economic crisis and the COVID-19 pandemic. This adds necessary real-world urgency to your study.

3. Theoretical Background and Hypotheses

This section is well-researched and shows that you’ve read broadly on the subject. The literature is synthesised clearly. However, I would encourage you to explicitly state your hypotheses. Right now, they are implied through the discussion but having them clearly laid out as bullet points or numbered statements would sharpen your contribution.

For example, you might write:

H1: Higher job satisfaction among healthcare professionals leads to greater patient satisfaction.

H2: The strength of the physician-patient relationship mediates this effect.

Adding such statements can help readers follow your empirical testing more easily.

4. Methodology

You’ve done impressive work here. You had large sample sizes and used validated instruments for both staff and patients. That’s not easy in real-world hospital settings.

However, I did notice a potential timeline issue. The staff satisfaction data ends in 2020, but patient satisfaction is measured until 2021. You mention excluding data beyond 2020 for regression purposes — a good call — but it might be helpful to clarify that earlier in the section.

Also, the explanation of endogeneity and your use of instrumental variables is extremely detailed. While it’s important, it might be too technical for the average reader in this section. Consider summarising the main points and moving the detailed statistical justifications to an appendix or supplementary section.

5. Results

This is where your study shines. The inclusion of demographic details — readers can really picture the people behind the numbers.

That said, your final matched dataset of only 97 observations is quite small compared to your initial samples. This should be framed as a limitation more directly. It's understandable — dyadic matching is hard — but readers need to know that this affects generalisability.

Your use of 2SLS regression is sophisticated, and the fact that professional satisfaction predicts patient satisfaction at a 1:1.12 ratio is striking. Just be cautious not to overstate it given the sample size.

6. Discussion

I really appreciate how you bring the discussion back to the patient-provider relationship in a human way. The points about patients needing dignity, empathy, clear communication, and involvement in their care feel authentic and grounded in real-world concerns.

At times, however, this section veers into a broader policy or reflective essay mode, which — while passionate — slightly detracts from your empirical findings. I'd suggest tightening this section to focus on the implications of your findings: how healthcare systems might use this data to guide staffing, training, or organizational change.

Also, reiterate that while your study found a relationship, causality is suggested but not proven, and further longitudinal work would help verify your claims.

7. Conclusion

This is a thoughtful wrap-up of your study. You nicely touch on how transforming the doctor-patient relationship can shift the quality of healthcare. I especially liked your suggestion that healthcare professionals need to be active listeners and collaborators — this gives a hopeful note to end on.

Again, I recommend gently underscoring the pilot nature of the work and encouraging future studies with larger, matched samples.

   8. References

Your references are up-to-date and well chosen. The diversity of sources — from empirical studies to theoretical frameworks — shows depth. Just make sure every citation is fully contextualized in the text, so it doesn't feel tacked on.

Comments on the Quality of English Language

Your writing is generally clear and formal — which suits the context — but could benefit from some editing for conciseness and clarity. Here are a few suggestions:

Avoid overly complex or academic words like veritably, manifesting, or endeavour when simpler alternatives would do.

Watch out for repetitive sentences or overlapping points (especially in the Introduction and Discussion).

A few syntactical or grammatical errors should be addressed (e.g., “At the cornerstone of medical lies…”).

Author Response

Open Review 3

( ) I would not like to sign my review report
(x) I would like to sign my review report

Quality of English Language

(x) The English could be improved to more clearly express the research.
( ) The English is fine and does not require any improvement.

 

	Yes	Can be improved	Must be improved	Not applicable
Does the introduction provide sufficient background and include all relevant references?	( )	(x)	( )	( )
Is the research design appropriate?	(x)	( )	( )	( )
Are the methods adequately described?	( )	(x)	( )	( )
Are the results clearly presented?	( )	(x)	( )	( )
Are the conclusions supported by the results?	( )	(x)	( )	( )

Comments and Suggestions for Authors

Dear Authors,

Thank you for letting me read your manuscript. Your topic is timely and important, especially regarding the growing importance of human relationships in healthcare. Connecting the satisfaction of healthcare professionals and patients is commendable. Below, I’ve outlined my thoughts and suggestions section by section to hopefully help you strengthen your already important work.

1. Title & Abstract

Your title sets the tone for the article well and clearly communicates that this is a pilot study, which helps manage reader expectations. However, it might flow better as:

"An Empirical Examination of the Interaction Between Healthcare Professionals and Patients in Hospital Settings."

The abstract summarises your work well but could be clearer in some areas. For example, the sentence “At the cornerstone of medical lies in the relationship…” is a bit awkward and would benefit from smoother phrasing. Try something like:

"At the heart of effective healthcare is the relationship between physicians and patients."

You do a good job presenting your findings here, especially by including the quantified relationship between staff satisfaction and patient satisfaction, but a touch more detail on the methodology (especially the use of 2SLS regression) would help orient readers unfamiliar with the technique.

1. Introduction

The introduction is rich in detail and reflects a sincere effort to frame the issue within existing literature. You touch on job satisfaction, patient expectations, and systemic challenges — all highly relevant. However, it does get a bit dense and could benefit from a more narrative flow. Consider trimming some of the repetition and guiding the reader more smoothly from the general topic to your specific research questions.

I appreciated your emphasis on the Greek healthcare context — especially the dual pressure of economic crisis and the COVID-19 pandemic. This adds necessary real-world urgency to your study.

1. Theoretical Background and Hypotheses

This section is well-researched and shows that you’ve read broadly on the subject. The literature is synthesised clearly. However, I would encourage you to explicitly state your hypotheses. Right now, they are implied through the discussion but having them clearly laid out as bullet points or numbered statements would sharpen your contribution.

For example, you might write:

H1: Higher job satisfaction among healthcare professionals leads to greater patient satisfaction.

H2: The strength of the physician-patient relationship mediates this effect.

Adding such statements can help readers follow your empirical testing more easily.

1. Methodology

You’ve done impressive work here. You had large sample sizes and used validated instruments for both staff and patients. That’s not easy in real-world hospital settings.

However, I did notice a potential timeline issue. The staff satisfaction data ends in 2020, but patient satisfaction is measured until 2021. You mention excluding data beyond 2020 for regression purposes — a good call — but it might be helpful to clarify that earlier in the section.

Also, the explanation of endogeneity and your use of instrumental variables is extremely detailed. While it’s important, it might be too technical for the average reader in this section. Consider summarising the main points and moving the detailed statistical justifications to an appendix or supplementary section.

1. Results

This is where your study shines. The inclusion of demographic details — readers can really picture the people behind the numbers.

That said, your final matched dataset of only 97 observations is quite small compared to your initial samples. This should be framed as a limitation more directly. It's understandable — dyadic matching is hard — but readers need to know that this affects generalisability.

Your use of 2SLS regression is sophisticated, and the fact that professional satisfaction predicts patient satisfaction at a 1:1.12 ratio is striking. Just be cautious not to overstate it given the sample size.

1. Discussion

I really appreciate how you bring the discussion back to the patient-provider relationship in a human way. The points about patients needing dignity, empathy, clear communication, and involvement in their care feel authentic and grounded in real-world concerns.

At times, however, this section veers into a broader policy or reflective essay mode, which — while passionate — slightly detracts from your empirical findings. I'd suggest tightening this section to focus on the implications of your findings: how healthcare systems might use this data to guide staffing, training, or organizational change.

Also, reiterate that while your study found a relationship, causality is suggested but not proven, and further longitudinal work would help verify your claims.

1. Conclusion

This is a thoughtful wrap-up of your study. You nicely touch on how transforming the doctor-patient relationship can shift the quality of healthcare. I especially liked your suggestion that healthcare professionals need to be active listeners and collaborators — this gives a hopeful note to end on.

Again, I recommend gently underscoring the pilot nature of the work and encouraging future studies with larger, matched samples.

8. References

Your references are up-to-date and well chosen. The diversity of sources — from empirical studies to theoretical frameworks — shows depth. Just make sure every citation is fully contextualized in the text, so it doesn't feel tacked on.

 

Comments on the Quality of English Language

Your writing is generally clear and formal — which suits the context — but could benefit from some editing for conciseness and clarity. Here are a few suggestions:

Avoid overly complex or academic words like veritably, manifesting, or endeavour when simpler alternatives would do.

Watch out for repetitive sentences or overlapping points (especially in the Introduction and Discussion).

A few syntactical or grammatical errors should be addressed (e.g., “At the cornerstone of medical lies…”).

Submission Date

28 March 2025

Date of this review

10 Apr 2025 15:27:59

© 1996-2025 MDPI (Basel, Switzerland) unless otherwise stated

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Responses to Review 3

1. Title & Abstract

Your title sets the tone for the article well and clearly communicates that this is a pilot study, which helps manage reader expectations. However, it might flow better as:

"An Empirical Examination of the Interaction Between Healthcare Professionals and Patients in Hospital Settings."

The abstract summarises your work well but could be clearer in some areas. For example, the sentence “At the cornerstone of medical lies in the relationship…” is a bit awkward and would benefit from smoother phrasing. Try something like:

"At the heart of effective healthcare is the relationship between physicians and patients."

You do a good job presenting your findings here, especially by including the quantified relationship between staff satisfaction and patient satisfaction, but a touch more detail on the methodology (especially the use of 2SLS regression) would help orient readers unfamiliar with the technique.

• Response:
• If we're not mistaken, the journal doesn't allow changing the title according to which the article entered
• Τhe suggested phrase "At the heart of effective healthcare is the relationship between physicians and patients." was used. The suggestion was followed
• Α phrase about 2SLS regression analysis was added in lines 24-25, more specifically: “an essential method for researchers addressing endogeneity challenges in structural equation modeling,” within the contexts that define the words of the Abstract =300. The suggestion was followed

 

2. Introduction

The introduction is rich in detail and reflects a sincere effort to frame the issue within existing literature. You touch on job satisfaction, patient expectations, and systemic challenges — all highly relevant. However, it does get a bit dense and could benefit from a more narrative flow. Consider trimming some of the repetition and guiding the reader more smoothly from the general topic to your specific research questions.

I appreciated your emphasis on the Greek healthcare context — especially the dual pressure of economic crisis and the COVID-19 pandemic. This adds necessary real-world urgency to your study.

• Response: We have cut three lines and changed the order of the words between lines 45-64 in order to guide the reader more smoothly from the general topic to our specific research questions. The suggestion was followed

 

3. Theoretical Background and Hypotheses

This section is well-researched and shows that you’ve read broadly on the subject. The literature is synthesised clearly. However, I would encourage you to explicitly state your hypotheses. Right now, they are implied through the discussion but having them clearly laid out as bullet points or numbered statements would sharpen your contribution.

For example, you might write:

H1: Higher job satisfaction among healthcare professionals leads to greater patient satisfaction.

H2: The strength of the physician-patient relationship mediates this effect.

Adding such statements can help readers follow your empirical testing more easily.

• Response: We clearly stated the main research question and the 3 Hypothesis (H1, H2, H3) in bullets, see lines 131-142. The suggestion was followed

5. Methodology

You’ve done impressive work here. You had large sample sizes and used validated instruments for both staff and patients. That’s not easy in real-world hospital settings.

However, I did notice a potential timeline issue. The staff satisfaction data ends in 2020, but patient satisfaction is measured until 2021. You mention excluding data beyond 2020 for regression purposes — a good call — but it might be helpful to clarify that earlier in the section.

Also, the explanation of endogeneity and your use of instrumental variables is extremely detailed. While it’s important, it might be too technical for the average reader in this section. Consider summarising the main points and moving the detailed statistical justifications to an appendix or supplementary section.

• Response 1: The clarification also setted earlier in the section, see lines 181-182. The suggestion was followed.
• Response 2: As the study is pilot, and has not been presented in a similar way before, it is addressed to specialized readers like you, we definitely wanted the explanation of endogeneity to be complete and detailed, since it is usually not presented successfully in the literature. Also, the topic we present is peculiar and endogeneity underpins it, therefore we deliberately developed it in this extensive way.

 

6. Discussion

I really appreciate how you bring the discussion back to the patient-provider relationship in a human way. The points about patients needing dignity, empathy, clear communication, and involvement in their care feel authentic and grounded in real-world concerns.

At times, however, this section veers into a broader policy or reflective essay mode, which — while passionate — slightly detracts from your empirical findings. I'd suggest tightening this section to focus on the implications of your findings: how healthcare systems might use this data to guide staffing, training, or organizational change.

Also, reiterate that while your study found a relationship, causality is suggested but not proven, and further longitudinal work would help verify your claims.

• Response: Recognizing your concerns, we placed Section 5 “Limitations and Future Research” (lines 417-432) before the Discussion to focus on the implications of our findings: how healthcare systems could use these data to guide staffing, training, or organizational change, and how further longitudinal work would help verify our claims. The suggestion was followed.

 

7. Conclusion

This is a thoughtful wrap-up of your study. You nicely touch on how transforming the doctor-patient relationship can shift the quality of healthcare. I especially liked your suggestion that healthcare professionals need to be active listeners and collaborators — this gives a hopeful note to end on.

Again, I recommend gently underscoring the pilot nature of the work and encouraging future studies with larger, matched samples.

• Response: Recognizing your concerns, we placed Section 5 “Limitations and Future Research” (lines 417-432) before the Discussion to focus on how further longitudinal work would help verify our claims. The suggestion was followed.

 

8. References

Your references are up-to-date and well chosen. The diversity of sources — from empirical studies to theoretical frameworks — shows depth. Just make sure every citation is fully contextualized in the text, so it doesn't feel tacked on.

• Response: The suggestion was followed.

 

Comments on the Quality of English Language

Your writing is generally clear and formal — which suits the context — but could benefit from some editing for conciseness and clarity. Here are a few suggestions:

Avoid overly complex or academic words like veritably, manifesting, or endeavour when simpler alternatives would do.

Watch out for repetitive sentences or overlapping points (especially in the Introduction and Discussion).

A few syntactical or grammatical errors should be addressed (e.g., “At the cornerstone of medical lies…”).

• Response: The suggestion was followed.

 

All upgrades are presented in the text in yellow for your convenience.

Thank you for your contribution to improving this research study.