Gaps in Reporting Greenhouse Gas Emissions by German Hospitals—A Systematic Grey Literature Review
Round 1
Reviewer 1 Report
The mere assumption of the article as a literature review to identify gaps in the reporting of greenhouse gas emissions from German hospitals is not suitable for a scientific publication. It seems that such a problem should be considered on the basis of official documents that are not published in Google databases. Such a literature review does not contribute anything to the problem of reducing emissions from hospitals, which makes it of little scientific and disciplinary value. The literature review is also not correct-items are not systematized, and some quotations in the literature are incomprehensible- this applies to Table A6 and its references (example: Jen's Universitätsklinikum, Umweltschutzbericht 2018. 2019). - This is a list of selected hospitals, and the links lead to different environmental reports that are from different years, so there is no reason to compare them (for example, two different hospitals, one from 2008 and another from 2018). The literature itself is incorrectly formatted. It is also found that there is a lack of convection - the text mentions Table A6, for example, and the signature of the table indicates that it is simply Table 6. The method used in the article is time-consuming, unreliable, and does not lead to any conclusions - except the obvious ones, which can be reached after the title itself without looking at the work.
Author Response
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Author Response File: 
Author Response.pdf
Reviewer 2 Report
The methods used in this literature review is well described in the paper, rigorous and novel. Results, discussions and recommendations are also comprehensive. My main concern is that the authors presented that the health sector (including hospitals and others) is currently responsible for 6.7% of the national GHG emissions (Line 302). This appears to be a small percentage of the overall emissions in the nation. Therefore, cutting emissions in this sector (even if a large portion) may not make a big difference in the overall amount and thus not very likely to generate a significant heath co-benefits as projected in the paper (Line 311-312). I'd like to see more explanations why it is important to mandate hospitals to report their emissions in order to achieve the reduction target. Without further discussing that matter, the significance of this study will be discounted considerably. Other comments:
1. The paper mentioned "no legal obligation for hospitals to report their GHG emissions exists" (Line 271). I was wondering why some hospitals still chose to report. That evidence may be the basis for the government to create some incentives for reporting if national legal obligation is not possible.
2. All references starting in #46 are not in English and need translation.
Author Response
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Author Response File: Author Response.pdf
Reviewer 3 Report
This is a very timely and important paper that should be published. It discusses an emerging problem, measuring and reducing GHG emissions from the health sector, and health care facilities in particular. The authors searched the grey literature, which is the appropriate approach in a field that it is unlikely to be covered by the peer reviewed literature. Finally, the authors show how a highly developed country, which often leads in matters related to climate change, still lacks action on the health sector, calling for increased response in this area.
Minor comments:
Note reference errors in lines 136, 160, 213
Figure 2 is not needed. All information is in the text
Please fix reference 4, line 411. (“Organization, W.H. should be World Health Organization)
Appendix tables. Hard to read as all text is centred. Please do left formatting
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Acceptance as corrected.
Reviewer 2 Report
The authors have addressed all my concerns and the paper is now in good shape.
