An Exponentially Distributed Stochastic Model for Sustainability Measurement of a Healthcare System
Round 1
Reviewer 1 Report
Authors are suggested to address the following comments. A reply to reviewer is recommended to be attached in revision.
1. Abstract, it is recommended to highlight the findings and advantages of proposed method numerically.
2. Introduction, paragraph 1, authors are suggested to explain more on the concepts of WS and SS.
3. Introduction, paragraph 1, it is suggested not to quote the URL directly in main text. Reference [x] could be used.
4. Introduction, paragraph 3, ICT has been defined twice.
5. After equation (1), authors mentioned there are 9 types of statistical distributions in which exponential distribution is the main focus of this paper. It would be nice if authors could state the unique advantage/benefit of this distribution.
6. Introduction, last paragraph, authors mentioned “Previous studies were based on the basic assumption of the normal distribution;…”, please quote the references.
7. Introduction, authors are suggested to improve the organization by dividing the long paragraph into several pieces.
8. Section 2.1, authors refer Sus as “sustainability of the company”. However, the title of the manuscript is related to healthcare system.
9. Equation (5), is it typo for the double integral of f_h,c(h,c)d_cd_h? It is repeated twice.
10. What are the situations of using equation (5) and (6)?
11. Equation (7), y=0 should be included.
12. After equation (8), authors mentioned “This study aligns with a previous probabilistic model with the significance… percentages [36].” It is difficult to understand and please elaborate more.
13. Please use “.” instead of “,” for numerical figures as convention.
14. Authors are suggested to elaborate more on the simulation tool.
15. Tables 2-4, are they retrieve from any reference?
Author Response
Point 1: Abstract, it is recommended to highlight the findings and advantages of proposed method numerically.
Response 1: The authors thank the reviewer for finding time to provide once again a through critique of our manuscript. We are grateful for this comment about the abstract. The following statement has been added to the abstract to highlight the findings and advantages of the model “In the results obtained, sustainability index for environmental, economic and social are 54.40%, 48.80% and 66.80% respectively. It indicates the healthcare achieved some sustainability through the social aspect; therefore, improving environmental and economic aspect of the TBL is necessary.”
Point 2: Introduction, paragraph 1, authors are suggested to explain more on the concepts of WS and SS.
Response 2: Thank very much. The below statement was added to the first paragraph to give brief understanding of WS and SS.
“It may be recalled that sustainability involves finding balance between the depletion and conservation of resources. It is the level of the resources (natural, environment and capital) the previous generation is bequeathing to the coming generations; however, losses in some natural resources are enviable [8]. Some researchers have argued for the belief that losses in the natural resources can be compensated through increased capital. Others maintained the belief capital cannot be substituted for resources. In this regards, therefore, two major views have surfaced in defense of sustainability as follows (i) stock wealth to be inherited by the coming generation cannot be less than the amount inherited by previous generation and (ii) stock of environmental assets bequeathed to the coming generation must the same inherited by the previous generation [9,10]. This is the basic concept of weak and strong sustainability respectively [11].”
Point 3: Introduction, paragraph 1, it is suggested not to quote the URL directly in main text. Reference [x] could be used
Response 3: We appreciate this comment about the URL cited within the manuscript. We have deleted the URL from this paragraph. It has been added with a parenthesis with reference 15
Point 4: Introduction, paragraph 3, ICT has been defined twice.
Response 4: Thanks for this careful observation. The definition of ICT in the preceding statement has been deleted
Point 5: After equation (1), authors mentioned there are 9 types of statistical distributions in which exponential distribution is the main focus of this paper. It would be nice if authors could state the unique advantage/benefit of this distribution.
Response 5: Many thanks for asking for clarification on the advantages of the exponential distribution proposed in our study. Actually, two of the major advantages of the distribution were included in the paragraph. However, we take responsibility for not clearly stated these out. We have adjusted the fourth statement under the paragraph to now read
“Some of these unique advantages include (i) existing within the continuous probability distribution domain with constant failure rate (lambda) suitable for analyzing real-life situations, (ii) possessing a constant response time and forms a veritable tool for predicting the mean time of the variables.”
Point 6: Introduction, last paragraph, authors mentioned “Previous studies were based on the basic assumption of the normal distribution;…”, please quote the references.
Response 6: Once again, we than the reviewer for the comment. A reference has been added to the statement. The statement now read
“Previous studies [20] were based on the basic assumption of the normal distribution”
Point 7: Introduction, authors are suggested to improve the organization by dividing the long paragraph into several pieces.
Response 7: Thank you. The Introduction have been divided into more paragraphs
Point 8: Section 2.1, authors refer Sus as “sustainability of the company”. However, the title of the manuscript is related to healthcare system.
Response 8: We appreciate you for pointing out this important issue. The work “ Company” has been changed to “ healthcare system”
Point 9: Equation (5), is it typo for the double integral of f_h,c(h,c)d_cd_h? It is repeated twice.
Response 9: Appreciation for detecting this error. We have deleted the repeated part
Point 10: What are the situations of using equation (5) and (6)?
Response 10: We accept not being explanatory about a basic fact about the proposed exponential model.
Exponential random variable involves time of an event and time between two events. In the case of time of an event, sustainability is measured base on “challenge cannot surpass capacity” given in Eq. 5. Similarly, for the second case, time between two events, sustainability is profiled on “capacity cannot surpass challenge” also given in Eq. 6.
For instance, for the first case time of an event, if the capacity is defined as time of staff training, then the increase in time spent (hours or days of the training) for the training must increase. In this instance, Eq. 5 is employed to determine the sustainability. Similarly, for the second case, time between two events, if challenge is defined as time between two complaints, then the decrease in time interval at which at least two complaints are reported must decrease (lower rate of complaint). In this situation, Eq. 6 is used to measure the sustainability of the system.
For this present work, the indicators are measured as the time the particular event took place. Hence, Eq. 5 is employed to measure the sustainability of the healthcare system.
We have elaborated more on the deductions of these two equations. We belief this will make it clearer to the readers.
We have added a statement to explain the situation of these equations.
“Exponential random variable involves time of an event and time between two events. In the case of time of an event, sustainability is measured base on “challenge cannot surpass capacity” given in Eq. 5. Similarly, for the second case, time between two events, sustainability is profiled on “capacity cannot surpass challenge” also given in Eq. 6.
For instance, for the first case time of an event, if the capacity is defined as time of staff training, then the increase in time spent (hours or days of the training) for the training must increase. In this instance, Eq. 5 is employed to determine the sustainability. Similarly, for the second case, time between two events, if challenge is defined as time between two complaints, then the decrease in time interval at which at least two complaints are reported must decrease (lower rate of complaint). In this situation, Eq. 6 is used to measure the sustainability of the system.
For this present work, the indicators are measured as the time the particular event took place. Hence, Eq. 5 is employed to measure the sustainability of the healthcare system.”
Point 11: Equation (7), y=0 should be included.
Response 11: Many thanks once again for this information. We have considered this comment while elaborating the said equation.
Point 12: After equation (8), authors mentioned “This study aligns with a previous probabilistic model with the significance… percentages [36].” It is difficult to understand and please elaborate more.
Response 12: Thank you so much especially for mentioning this statement. Our intention initially was to estimate sustainability using the ratio scale as explained by the cited reference. We later towed another dimension to measuring sustainability. We have therefore deleted this statement and the reference from the manuscript
Point 13: Please use “.” instead of “,” for numerical figures as convention.
Response 13: Author appreciates this comment. Adequate adjustments have been effected
Point 14: Authors are suggested to elaborate more on the simulation tool.
Response 14: We thank the reviewer for suggesting this comment. However, various revisions that have been added have given more insight to the manuscript. Indeed, specifically, in the light of explaining more about Eq. 5 and 6, we feel that the simulation tool has been elaborated.
Point 15: Tables 2-4, are they retrieve from any reference?
Response 15: We appreciate your comment about these tables. The tables were not retrieved from any reference. It is rather the sustainability indicators for the TBL coined based on the reality and the prevailing situations at the healthcare system. They were coined according to SMART through strict adherence to the convectional guidelines of SUSTHealth tool as presented in Table 1. We have added to explain how we arrived at Table 2-4 to the manuscript
“ Having strictly adhered to the conventional guidelines provided by SUSTHealth, Table 1 as given, Tables 2-4 presents the sustainability indicators (challenge and capacity) for the TBL with their rationales coined according to SMART and based on the prevailing situations at the healthcare system.”
Reviewer 2 Report
I recognize that the paper has extensively revised and that main data have been delivered to reviewers. Nonetheless, I still have doubts on data collection, the same questions that I am posing since the beginning: when were these data collected? By whom and how? When are these data referred to? There is only one reference to operating year 2016 in page 15, despite no reference is present in tables or in presentation of methodology.
Author Response
Point 1: I recognize that the paper has extensively revised and that main data have been delivered to reviewers. Nonetheless, I still have doubts on data collection, the same questions that I am posing since the beginning: when were these data collected? By whom and how? When are these data referred to? There is only one reference to operating year 2016 in page 15, despite no reference is present in tables or in presentation of methodology.
Response 1: Thanks for this important point.
First, we only refer to year 2016 being the year this monitoring and tallying of various indicators was conducted.
Second, the data were collated from the hospital. In 2016 the hospital filed to obtain ISO code. Consultants were to raise some factors that are germane for critical analysis of the operations of the healthcare system need to satisfy ISO code requirements. Much sustainability information were developed and observed during this period. Data for this study were extracted from this information and from the hospital and patient’s records. Also briefs were taken from the personnel (doctors, nurses, record officers, patients and patient relatives) according to the categories given in Table 1. With this brief, challenges and capacities for the TBL were selected, coined and refined.
These were returned back to the hospital personnel for verification and authentication. Thereafter, the service of qualified medical personnel was employed for tallying, monitoring and recording of values for the indicators in accordance with the rationales over a period of a year. We used this data mainly to check the applicability of the proposed model.
Round 2
Reviewer 1 Report
Thank you for addressing the comments. I have no further comment.
This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.
Round 1
Reviewer 1 Report
It can be seen that authors have improved the quality of manuscript after addressing the previous comments. There are some comments remain unaddressed properly as well as some new comments are given.
Follow-up comments:
1. Written English should be improved.
2. Section 1 and section 2 must be rewritten significantly with more focus on recently published articles (2014-2018).
3. The technical contribution in section 3 is not qualified as SSCIE-listed journal paper.
New comments:
4. Introduction, paragraph 1, authors mentioned “[1] Again posited that decision-makers increasingly seek to…”, it seems that [1] is not in proper location.
5. Authors are suggested to cite the following Sustainability paper in introduction as an inclusion of recently published paper in ‘Sustainability journal:
Chui, K., Alhalabi, W., Pang, S., Pablos, P., Liu, R., & Zhao, M. (2017). Disease diagnosis in smart healthcare: Innovation, technologies and applications. Sustainability, 9(12), 2309.
6. Section 3, paragraph 1, authors mentioned the populated capital, accommodation of patients, etc., please provide citation for this information.
7. Tables 1-2, are the contents repeat based on existing works? If yes, reference is required and only key information should be included (other contents should be moved to Appendix).
8. Figures 1-6, please add the p-value next to the figures.
9. Figure 9 should be numbered as Figure 7.
Reviewer 2 Report
The reviewer will list again some suggestions, already texted to the authors of this paper...
The paper works, and it is interesting..but there are some ethical issues that need to be reviewed.
At first you are citing works by an author referring to other authors. This is a very big problem.
- ITACA has no sense in this paper.. I suggest you to eliminate all the information about ITACA.. in addition, if you want to maintain it, please refer to the correct authors (Buffoli et al. (2015), isn't it ?
reference of ITACA, has a mistake, please verify the correct title of the book...
- TABLE 1 ... where did you find the project is called SMART ? the project is susthealth (Capolongo et al. 2015, Buffoli et al. 2013,.. the reviewer does not lost his time repeating the same information that he has already texted...)
- for the content of the tool (SustHealth, not SMART).. please refer to Bottero et al. (2015)
The references are incorrect:
1- the number of the references in the text are without sence...(i.e. you refer to Etkins et al. around ITACA evaluation system .. and they have never cited in their paper (?!?) - without referring to the correct author . this is a very big mistake !)
2- are you sure you can write... "recent studies of [9]" ? do the author have verified the journal guidelines ? Have they already read papers with similar citation style ?
Probably you should write: "Recent studies by Liu et al. (2017)" and at the end of the sentence "[9]".. PLEASE REVIEW ALL THE SENTENCES IN THE PAPER...
3 - please review the citation in the text "(See [32] 25:411:418)"..
In addition, it is requested to review the style of text: there are several mistakes in the grammar and words..
If the reviewer mistakes, please add a list with all the motivations. but starting from my research work, I think the authors need to review and to write correct information in their text. It is an ethical aspect, isn't it ?
If several ethical mistakes will be reported again in the paper, the next time, if the editor will contact me again, I will reject the work.
Reviewer 3 Report
The paper has been re-submitted with very poor revisions. Main concern regards data collection, thus precise information on when and how data were collected, which is still missing.
