Shaping the Future of Healthcare: Integrating Ecology and Digital Innovation

Round 1

Reviewer 1 Report

Firstly, I acknowledge the well-researched, grounded, and well-referenced article. The article addresses a contemporary discourse on Integrating Ecology and Digital Innovation. The title of the article is interesting and very clear. The aim of the study is precise and stated in the abstract: “to analyse the current scenarios of ecological and digital transition in the healthcare sector, considering their high energy consumption.” The literature review is comprehensive and well-cited, with contemporary references. That’s impressive. The results (presumably qualitative) are detailed, though the quantitative research approach mentioned seems misappropriate to the findings presented. The findings conclusion and “implications to policy” are thorough and precise.

However, I have picked up aspects that I feel should be addressed to strengthen the article, as stated below:

1). Abstract: The author should briefly outline the methodology/methods used in this article. This is not clear.

2). Line 26 – 86: The problem statement is precise. However, I expected to see the research questions or objectives this article seeks to address. These should be clearly stated.

3).  Line 361 – 362: “The printed questionnaire was distributed to top management and strategic management….” It should read, “The printed questionnaires were distributed to top management and strategic management….”.

4). Line 341 reads: “To verify our hypotheses, we surveyed within a major private hospital group in southern Italy in 2023.” You have clearly stated that your study used a survey questionnaire from top management for data collection. However, I expected to see the hypotheses clearly stated. This is missing! Moreover, you need to be precise as to how you have analyzed your statistical data, i.e., which software packages you have used, the statistical analysis carried out, etc. This information is crucial for any quantitative data analysis and should be incorporated. Moreover, you jumped from the Methodology section (Lines 345 – 365) to your discussion section (lines 366 – 403), but where are the statistical results generated from your survey? This section should examine and align the methodology with the findings presented.

5). Your study addresses implications to policy only (lines 390 – 396). Since this study is crucial to the healthcare fraternity, I suggest that you also address implications for practice within the field. Policies should guide medical practitioners, and constructive alignment should be monitored for effectiveness. Most organizations/ministerial departments may have sound policy documents in place, but implementation and monitoring remain a stumbling block.

6). The rest of the document looks good, and I have no issues with the results and discussions.

Author Response

We would like to express our gratitude for your invaluable feedback. We have proceeded to revise the paper according to your suggestions.

In particular, we have briefly outlined the methodology in the abstract, included the research questions in the introduction, provided detailed descriptions of the analysis method, the software utilized, and the results.
Finally, we have added a concluding paragraph discussing the implications for practice.

We appreciate the time you dedicated to this, and we hope that we have addressed all of your observations satisfactorily.

Author Response File: Author Response.docx

Reviewer 2 Report

The article is very interesting, but several problems must be addressed to improve the quality of the paper.

Introduction:

The introduction section explains the main research gaps. The authors should use updated references that are of great help and contain relevant context information, including environmental leadership, pro-environmental behavior, and corporate social responsibility policy. The end of the introduction is valued positively if the authors highlight the research purpose and contributions of the paper. Please revise this.

Literature discussion:

The literature discussion has the same problem. The author cited a lot of data to support their research topic. This article is positioned as a theoretical article, but there is no strong theory to support the structure of this research. For example, the author suddenly mentioned the long tail theory. Still, it seems like an explanation that suddenly supports a certain point of view, which is not the theoretical basis of the entire article.

The Literature review section is not well written although there is some literature to support the study. However, I suggest the article improve by adding the literature review section to the previous literature. Is important to justify reviewing the literature to examine the research questions and hypotheses. In particular, the literature review should be sufficiently developed and referenced for all variables and research conditions treated. However, there is a lack of an introductory literature review paragraph that links the sub-sections (such as 2-1,2-2,2-3…..) based on theoretical background and provides systematic research from the literature review. Please add this and polish it for the literature review.

Research Design and Research Model

The author uses the very common questionnaire method to collect data. However, the author does not clearly explain the analysis process and results, which may confuse readers. In addition, how do you handle common method bias and social desire bias?

Conclusion and Policy Implications
The conclusions section is not well summarized; the authors should add one or two paragraphs at the end of the conclusions regarding the research contribution.

Extensive editing of English language required

Author Response

In expressing our gratitude for your invaluable observations, we have proceeded to revise the paper following your suggestions.

Specifically, we have described the importance of green leadership, pro-environmental behavior, and corporate social responsibility policy. We then added the research purpose and the article's contributions.

Subsequently, we focused on reviewing the literature, analysis methods, software used, and results.

Finally, we inserted a concluding paragraph outlining the implications for practice and the research's contribution. We then subjected the entire article to a review of the English language.

We thank you for the time you dedicated to this, hoping to have addressed all your observations.

Author Response File: Author Response.pdf

Reviewer 3 Report

A publishable paper, essential topic. There is only one remark, for further submissions from the same study: In your report, there is a mention to "hypothesis". These must be evidenced, cited with appropriate space and reference. No harm for this one, as it can be perceived as an initial supporting paper.

Author Response

In expressing our gratitude for your invaluable observations, we have proceeded to revise the paper following your suggestions.

Specifically, we have described the importance of green leadership, pro-environmental behavior, and corporate social responsibility policy. We then added the research purpose and the article's contributions.

Subsequently, we focused on reviewing the literature, analysis methods, software used, and results.

Finally, we inserted a concluding paragraph outlining the implications for practice and the research's contribution. We then subjected the entire article to a review of the English language.

We thank you for the time you dedicated to this, hoping to have addressed all your observations.

Author Response File: Author Response.docx

Reviewer 4 Report

Good day.

The article is relevant and interesting, but needs some revisions:

1. To expand the critical analysis of the review of literary sources;

2. expand the conclusions to the set goal.

thank you

Author Response

In expressing our gratitude for your invaluable observations, we have proceeded to revise the paper following your suggestions.

Specifically, we have described the importance of green leadership, pro-environmental behavior, and corporate social responsibility policy. We then added the research purpose and the article's contributions.

Subsequently, we focused on reviewing the literature, analysis methods, software used, and results.

Finally, we inserted a concluding paragraph outlining the implications for practice and the research's contribution. We then subjected the entire article to a review of the English language.

We thank you for the time you dedicated to this, hoping to have addressed all your observations.

Author Response File: Author Response.docx

Reviewer 5 Report

The article shows very well that there is a significant need for measures across the entire healthcare system to move towards more sustainability in the use of our limited resources. The list of 10 points in the discussion chapter (lines 424-467) is particularly good and shows very specific measures. As a small structural improvement, a numerical listin of this 10 points would provide a little more structure (than simply naming the points).

As an additional point 11, I would mention that studies would be of interest in which areas reusable material can be increasingly used instead of disposable material (for example, before disposable plastic syringes, people used reusable glass syringes for injections and relied on reusable bandages instead of completely disposing of all this material after a single use).

In general, from the reviewer's point of view, this article lacks positive aspects of the healthcare system, which already contribute significantly to sustainability and the conservation of resources. I am thinking here in particular of the mobilization of patients who would otherwise use significantly more resources due to their illness. Such factors would be, for example:

- ongoing medication intake

- Doctor visits

- Trips to the hospital, etc.

My recommendation would be to address the above-mentioned aspects (and maybe more other similar aspects) in this article - perhaps in a separate chapter - in order to provide a somewhat more comprehensive presentation of the problem.

Author Response

We would like to express our gratitude for your invaluable observations. We have proceeded to revise the paper based on your suggestions.

In particular, we have described the importance of green leadership, pro-environmental behavior, corporate social responsibility policy, and the significance of material reuse. We then added the research purpose and the contributions of the article.

Subsequently, we focused on reviewing the literature, analysis methods, software used, and results.

Finally, we inserted a concluding paragraph outlining the implications for practice and the research's contribution. We then subjected the entire article to a review of the English language.

We thank you for the time you dedicated to this, hoping to have addressed all your observations.

Author Response File: Author Response.docx