Reviewer’s report

Title: Reducing waiting time and raising outpatient satisfaction in a Chinese public tertiary
general hospital-an interrupted time series study

Version: 0 Date: 12 Jul 2017

Reviewer: Katherine Harding

Reviewer’s report:

This is an interesting paper exploring the relationship between waiting times for outpatient
services and patient satisfaction. The findings support previous literature, but I think they do
make a meaningful contribution by demonstrating the inverse relationship between waiting time
and satisfaction in China, in contrast to much of the literature in this area that has come from
Western healthcare settings.

There are a number of minor errors in English grammar are present throughout the paper.
Editing specifically by a person who is familiar with writing in English in an academic style
would be worthwhile to correct these errors. Otherwise the paper is clear and well written.

Abstract

The methods/results sections in the abstract could be adjusted to include some detail that is
useful to readers at first glance - eg the sample size and the actual reductions in waiting time
(that is, from what to what, rather than just the difference). Other details could be removed to
accommodate this - the software used doesn't need to be in the abstract for example.

Introduction

The introduction is clear and concise.

Methods

The content of the methods section is appropriate, but I feel that some reorganisation of this
section would help to make the flow more clear and logical. I suggest organising subheadings as
follows:

1. Study design - a very brief overview of the study design - eg. including lines 29-36, but
moving the definitions of waiting time to the relevant paragraphs in the description of the
outcome measures. Paragraph 2 of the existing study design section could go into the analysis
section, and paragraph 3 could be incorporate into the relevant sections describing the surveys.
2. Population and setting - paragraph one of this section could be expanded to provide a broad
overview of the setting. What type of population does this hospital serve? Is it
metropolitan/rural? Some brief demographic data would be useful, and perhaps something about
the size of the hospital (total consultations per year, for example) would be useful here to provide
context for readers not familiar with China's health system. There is a sentence along these lines
in the introduction that could be moved from the introduction into this section. The current
paragraphs 2 and 3 of this section could be moved to the following sections on data sources.

3. Intervention - The existing section titled "Efforts to reduce waiting time and improve
outpatient satisfaction…." would be better placed here, under the subheading "Intervention". A
couple of brief introductory sentences that Incorporate the existing subheading could provide an
overview of the efforts made, followed by the existing subheadings "situation mapping",
"deficits identification", patient flow analysis" and "comprehensive interventions". I think the
final subheading "patient satisfaction survey" belongs with the data sources section.

4. Data Sources - This section could be broken down with further subheadings, including
"routinely collected data", "patient satisfaction surveys" and "Nationa; patient surveys". The first
would include most of the information already in the Data sources section. The second two
subheadings would bring together information that is currently spread across other sections into
specific paragraphs describing the processes for collecting survey data, how patients were
sampled etc.

5. Outcome measures - as currently described

6. Analysis - as currently described.

Results

It would be useful in the results section to state what the waiting time went from and to. For
example "an immediate decrease of waiting time of 3.4 minutes, from 23 mins to 19.9
minutes…." (please note these figures don't quite seem to agree between the text and Table 1 -
please check this). A reduction of 3 minutes isn't very meaningful if people are waiting 63
instead of 60 minutes. However a drop of 3 minutes from 15 to 12 is more substantial. Therefore
the total waiting time is important here for context and should be available in the text without
having to look to the tables.

Tables 1 and 2 is not particularly helpful to the reader - there are too many figures here to be
meaningful I suggest either deleting this table, or reducing into averages across 5 broader time
bands. Figures 1 and 2 are much more interesting and easier to interpret and I think would be
sufficient without the tables.

Discussion
The points made in the discussion are good, but I think could focus more on the things that are
most interesting about this paper. To me, these are:

- That the paper reinforces previous findings about a correltation between waiting time and
patient satisfaction. This point is already well made by the authors.

- A discussion about specific contextual factors in China that may influence satisfaction.
Are there factors that you would expect to be similar or different to studies conducted elsewhere?
This is a key point of difference for this paper and was set up as justification for the study in the
introduction, so would be good to elaborate on this.

- Comments on the effectiveness of the interventions could be brought together in a single

paragraph of the discussion, but the authors should be careful not to overstate their findings. For
example, p. 9 line 15 I suggest using terms such as "findings provide evidence in support…."
rather than "the external comparisons prove…"

- The increased strength of the relationships with pharmacy waiting time and satisfaction
compared with consultation waiting time/satisfaction is interesting. It is likely that patients see
the filling of a prescription as more of process and therefore strongly influenced by time,
whereas there are different expecations of the doctor consultation and other factors at play here.
Previous studies, including one by our own group (Harding, KE and Taylor, NF (2010). Highly
satisfied or eager to please? Assessing satisfaction among allied health outpatients. International
Journal of Therapy & Rehabilitation 17(7): 353-359) have found that interpersonal relationships
are very important in patient satisfaction, and therefore patients who had to wait but then had a
good experience with their doctor are still likely to be satisfied.

Are the methods appropriate and well described?

If not, please specify what is required in your comments to the authors.

Yes

Does the work include the necessary controls?

If not, please specify which controls are required in your comments to the authors.

Yes

Are the conclusions drawn adequately supported by the data shown?

If not, please explain in your comments to the authors.

Yes

Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify what aspects require further
assessment in your comments to the editors.
I am able to assess the statistics

Quality of written English

Please indicate the quality of language in the manuscript:

Needs some language corrections before being published

Declaration of competing interests

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3. Do you hold or are you currently applying for any patents relating to the content of the
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