Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

In the paper, the research question is not made particularly apparent. You must state the issue you're trying to solve in detail and demonstrate how your study advances the field. What kind of hole, for example, are you trying to fill? Making this clear will help readers grasp the significance of the work and give it greater direction.

A literature review is missing and should be included. This section is key to showing how your work fits into the broader academic discussion. You should reference similar studies in the field and highlight what makes your research unique. Adding recent papers on sustainability and peer-review systems will strengthen your paper’s foundation.

The methodology section is quite underdeveloped. It's not clear how participants were chosen, what tools were used, or how data was collected. For example, if you had a small number of participants, why was this sample size appropriate? Adding more details here will make the study more credible.

The diagram in your paper is useful, but the explanation isn’t detailed enough. Each element in the diagram needs to be discussed more clearly, with examples. For instance, how do the elements interact, and what is their role in your argument? A step-by-step breakdown of the diagram would make it more understandable.

The number of participants is small, which weakens your conclusions. If it's impossible to increase the sample size, you should justify why this number is sufficient or explain how it might affect the generalizability of the study. It’s better to be upfront about limitations.

The results section feels a bit rushed and lacks structure. Presenting your findings in tables or charts could help make the results more digestible. Also, you need to go deeper into analyzing the results. For example, did you notice any trends in the data that support your argument?

Additionally, for the discussion section is imperative that you demonstrate how the findings relate to the larger picture and link them back to your initial research topic. Did your results support previous theories or are they at odds with those of other studies in the same field? Examining these ideas would strengthen the argument made in the discussion.

Your conclusion should restate the importance of your results and provide a more concise summary of your main arguments. It would also be beneficial to include recommendations for future study directions, such as how to apply your findings to other sustainability issues.

The paper lacks enough references. To strengthen your arguments, make sure to cite relevant studies and recent scholarship. For example, if you’re discussing a new model for sustainability, mention any similar models used in other studies. More engagement with sources will help anchor your paper in the academic conversation.

The English is understandable, but there are some awkward sentences that could be clearer. Moderate editing is needed to improve readability. It would be helpful to have someone else review the text or use a language tool to fix these issues. This will make your ideas easier to follow.

The structure of the paper could be improved for better flow. The sections need to connect more logically. Starting with a clear research question, then moving to the literature review, methodology, results, and discussion, would help guide the reader. This will improve how persuasive the argument feels.

Finally, a stronger justification for why this study is important to the field of sustainability is needed. Why should readers care about this topic now? Including some context about current global sustainability efforts will show that your research is timely and relevant. This will also highlight the importance of your findings more effectively.

Comments on the Quality of English Language

The English language is mostly understandable, but there are several areas where sentence structure could be improved for clarity and flow. Moderate editing is needed to fix awkward phrasing.

Some sections of the paper contain minor grammatical errors and could benefit from a review by a native speaker to improve readability and make the text smoother.

Author Response

Dear Ms/Mrs. Reviewer,

Please find attached document with responses to you 

comments.

Thank you in advance for your interest.

Best regards, 

Anastasia Vasileiou

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Sustainability-3181080, Exploring Sustainability and Efficiency Improvements in Healthcare: A Qualitative Study, the research topic presented in the manuscript is impressive and holds significant potential. However, I have some concerns regarding the structure and clarity of the paper that need to be revised and follow the below suggestion.

 1. Please rewrite your abstract to ensure clarity and conciseness. It should succinctly highlight the study's main goals, techniques, findings, and results. Try to make it interesting and approachable for readers.

2. Please carefully note that the manuscript contains numerous figures, but the research methodology is not clearly articulated. While you mention the use of data, there is a lack of detailed analysis. It would be beneficial to outline the data sources and the analytical techniques used explicitly. Currently, it isn't easy to understand the content of the manuscript to the figures presented. 

3. I feel the authors are not very clear; many figures appear in the manuscript, yet their relevance and connection to the text are unclear. Please ensure that each figure is adequately referenced and explained in the context of your findings; it’s very important to correct them.

4. The authors mention several aspects in the methodology section, but I am unable to find the corresponding details or evidence to support these claims. It is essential to provide clear and specific information regarding the methods used in the research to enhance transparency and reproducibility. “Lines 45 to 50: This chapter outlines the research methodology employed in this study to explore the initial opinions and insights of healthcare providers and scholars toward the adoption of sustainable Lean Six Sigma practices in healthcare and hospital settings. The study adopts a qualitative research approach, utilizing semi-structured interviews to gather in-depth information from participants. This chapter provides a detailed description of the research design, participant selection, data collection methods, and the analytical procedures used to interpret the data”.?

Good Luck

Comments on the Quality of English Language

Minor editing of English language required.

Author Response

Dear Ms/Mrs. Reviewer,

Please find attached document with responses to you 

comments.

Thank you in advance for your interest.

Best regards, 

Anastasia Vasileiou

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

First of all, I would like to thank the authors for the opportunity to read this paper. The subject is both interesting and engaging.

The authors explore the theme regarding Sustainability and efficiency improvements in healthcare, a subject of great importance.

Still, in order to enhance the quality of the paper, I would make a few recommendations, namely:

- specifying the source of the figures included in the paper;

- restructuring the Introduction part and the larger section where the theoretical basis can be explored, in order to better understand the importance of the subject;

- the Introduction should offer a general presentation of the subject and at the end of this part, a brief presentation of the rest of the content could be included, mentioning what information does every of the following sections contain;

- the research question should derive from the analyzis of the literature (currently they are included in the Introduction), while the objectives should be specified in the Matherials and Methods section;

- Currently, the research questions are numbered as 5, but there are listed 10. The reason for this should be also explained.

- Is the sample studied representative for a larger population? Why were there only 16 participants? 
- The authors could consider extending the study on a larger sample and including a quantitative analysis on the subject.

Author Response

Dear Ms/Mrs. Reviewer,

Please find attached document with responses to you 

comments.

Thank you in advance for your interest.

Best regards, 

Anastasia Vasileiou

Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

The research is well structured and carried out. One thing to consider is that in order to use the conclusions in a generalized vision, it is necessary to take into account the different existing health systems in the world. In fact, the authors' conclusion that private hospitals are advantaged by the application of the GLSS may be true in the Greek health system. In other countries, including Italy, this is not yet true. However, apart from these considerations, the paper is valid and I believe it can be published as it is.

Author Response

Dear Ms/Mrs. Reviewer,

Please find attached document with responses to you 

comments.

Thank you in advance for your interest.

Best regards, 

Anastasia Vasileiou

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The introduction offers enhanced background; nonetheless, it may benefit from a stronger connection to contemporary research on Green Lean Six Sigma (GLSS) within healthcare and other sectors. Enhancing the literature review with current references and other theoretical frameworks would augment the scholarly rigor of your paper.

The methodology section has been enhanced with more explicit descriptions of the semi-structured interviews and participant selection process. Nevertheless, further information regarding the sampling methodology, data analysis techniques, and possible biases in the selection process will improve the transparency and credibility of your research.

The discourse on the findings is more cohesive; nonetheless, the arguments remain rather biased. Although the advantages of GLSS are highlighted, the obstacles, including resource constraints and reluctance to change, warrant further elaboration. Incorporating further examples of the challenges encountered by participants will yield a more equitable perspective.

The results are more effectively presented, especially with the inclusion of demographic data. It would be beneficial to incorporate more visual aids, such as tables or graphs, to encapsulate crucial findings. This will facilitate the comprehension of results and elucidate significant insights more distinctly.

The findings are progressing appropriately; however, they require stronger data support. The conclusion should more thoroughly address the obstacles already identified, including training requirements and cost limitations, despite the mention of the potential benefits of GLSS, to offer a more comprehensive summary of the study.

The referencing has enhanced, however further engagement with contemporary empirical research on GLSS in healthcare and other sectors remains necessary. Incorporating more contemporary sources will strengthen the academic foundation of your paper and illustrate a more robust alignment with current research trends.

Comments on the Quality of English Language

The English language is predominantly clear; nonetheless, certain sections have grammar faults and poor phrasing. An assessment of the language would enhance clarity and readability, especially in the more technical sections of the article.

Author Response

Dear Ms/Mr. Reviewer,

Please find attached document with responses to you 

comments /Round 2.

Thank you in advance for your interest.

Best regards, 

Anastasia Vasileiou

 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Congratulations to all three authors. After revision, the authors have improved their manuscript according to the reviewers' suggestions and recommendations. I accept this article for publication, with minor corrections needed before the paper goes online.

Please replace "Chapter" with "Part" or "Section." "Chapter" is still used in lines 556, 606, 671, 674, 774, and 888.

Comments on the Quality of English Language

Minor editing of English language required.

Author Response

 

Dear Ms/Mr. Reviewer,

Please find attached document with responses to you 

comments /Round 2.

Thank you in advance for your interest.

Best regards, 

Anastasia Vasileiou

 

Author Response File: Author Response.docx