Writing a quality improvement paper

Institute for Healthcare Improvement (IHI)

Asia Pacific Forum on Quality Improvement in Health Care National Quality Improvement Day

Ko Awatea 19 September 2012

Professor Felicity Goodyear-SmithDepartment of General Practice & Primary Health Care University of Auckland

Cooking up that publication

Make the time

• Pressure cooker approach: set aside block of time

• Casserole: slowly over time

• Slowly over time

Organisation: storage

• Keep all project files in 1 folder

• +/- sub-folders

• Include Endnote (bibliography) file

Preparation

Assemble your ingredients

• Grant proposals

• Ethics application

• Data set

• Study reports

• Reference list

Preparation

Organise your utensils

• Literature databases

• Bibliography software (Endnote)

• Instructions for authors: (see journal)

Are you working on your own?

or do you have collaborators?

Rules for co-authorship

Substantial contribution to:

1. Conception & design, or analysis & interpretation of data

PLUS

2. Drafting article or revising critically for important intellectual content

Rules for co-authorship

Be inclusive but exclude sleeping partners

Participation solely in acquisition of funding OR collection of data does not justify authorship

Too many cooks…

1.Need one person to take control

2. May assign roles to others

Amendments

• Track-changes

• Highlighter

• Paper versus electronic

Lead writer

• Nag your co-authors (gently)

• May have to spoon-feed

• Set time limits for response

Chose your journal

Who is the audience?

Weigh up target readers / impact factor

Journal IF

eg

New Eng Med J = 50

BMJ = 13.7

NZMJ = 0

JPHC = watch this space

Target audience eg

world scientists

NZ academics

local GPs

your mother

Start at the top?

• Is there any chance of top journal publishing this?

• Will it provide good reviewer comments?

• Will it take long?

What type of journal?

• NZ or international?

• UK / Europe, North America

Australasia

• General medical or primary health care?

Sub-speciality? Think laterally?

Open access (e-journal only)?

Article processing charge of £1125/US$1835/€1285 payable for articles accepted for publication.If your institution, society or other organization is a BioMed Central member, this cost may be wholly or partly covered by

the membership arrangement.

Break here for promo

Advertise

ment

Peer-reviewed journal of RNZCGP

•Replaced NZ Family Physician 2009

(35 yrs, not MEDLINE)

•MEDLINE achieved 2010

• Pacific rim: Māori, Pacific & Asian health issues

• Fields include:

– Clinical practice

– Health care delivery

– Health promotion

– Epidemiology

– Public health

– Medical sociology

Scope

• Quantitative

• Qualitative

• Mixed method

• Systematic review

& meta-analysis

• Improving performance

• Case reviews

Rigorous peer review

Original research

Writing for Journal of Primary Health Care

Instructions for authorsFollow instructions!Templates for: • Quantitative papers• Qualitative papers

• Improving performance papers• Patient consent formsInstructions for peer reviewers• Template for peer reviews

editor@rnzcgp.org.nz

Back to writing workshop:

Other aspects to weigh up

• Fits aim & scope of journal

• Rejection rate of journal

• Speed of journal turn-around

Ways to find journal

• Check journals in your reference list

• Ask colleagues

• Medline / Embase etc

• Google

Journal Citation Reports

1 University of Auckland library databases

2 Web of Science – connect

3 Select a Database –4 Journal Citation Reports

o Science & Social Science directories

o Search by subject category o or by title word eg ‘Quality’

Check instructions for authors

• Check journal website

Check rules:

• Size, structure of Abstract

• Word count

• Layout

• Reference style

Getting started

Set up template:

•Page set-up

•Font type & size

•Language

•Page numbers

•Headings / subheadings

Can start draft while project in process

Model paper

Use exemplary paper as model

Identify early

What is already known

What new knowledge you add to

the basket

Now you’re cooking…

•Clarify aim

• Cut & paste Intro / background & methods from proposals, ethics applications, reports etc

Title

To whet the appetite

“The black hole of GP manpower”

“Pandora's e-box: general practitioners reflect upon email communication with their patients”

Include study design? Eg RCT, systematic review

Key words

• http://www.ncbi.nlm.nih.gov/sites/entrez?db=MeSH&term

• Check journal articles for relevant words

Medical Subject Heading Terms (MeSH)

Standard IMRAD format

• Introduction WHY?

• Method HOW?

• Results WHAT?

(Findings if qualitative) And

• Discussion SO WHAT?

Introduction

Why you did it

•What is available?

•Where is the gap?

Aim

What you planned to find out or create to fill the gap

Methods

What you did

Setting Sample

Inclusion Exclusion

Methods

• Design Analysis

Design Analysis

How you did it

Results

What you found, what you created

• Describe sample,

response rate

Results

What you found, what you created

Text OR

figures & tables

Discussion

Principal findings:

Strengths Weaknesses

Mmmm….

Discussion

Meaning / implications :

• how this fits in

• Unanswered questions

/ future research

OR Quality improvement report

Follow the structure used by BMJ Quality & Safety

•Background

•Assessment of problems

•Results of assessment /measurement

•Strategies for quality improvement /change

•Lessons and messages

Background

Outline of problem eg.

– What was the problem that was identified for study (problem definition)?

– How was it identified?

– Why was it a priority?

– What were the stated objectives of audit?

Background

Outline of context (local and wider) eg

– Relevant details of local hospital/practice, etc

– Local internal organisation and structures relevant to the problem

– Wider context of the problem

Outline of staffing arrangements eg

– Staffing arrangements such as how staff work together

Assessment of problems

Detail of the approach taken with justification eg

– Criteria based audit /critical incident /routine monitoring / TQM tools and techniques.

Criteria, standards or guidelines developed eg

– Who set them and how they were developed?

– Were they considered ideal or realistic?

Assessment of problems

Measurement of problem eg

– How was this done?

– Who did the assessment?

– How was it analysed?

Results of assessment /measurement

How results were used to understand the problem eg

– How results were put into local context

– Implications for improving the quality of care

– Implications for change

Strategies for quality improvement / change

Feeding back information to relevant staff eg

– How this was done?

– Why was this approach chosen?

– Who was included?

– What was their responses?

Strategies for quality improvement / change

Mechanism for change eg

– What course of action was taken and why?

– Was this justified by the results and context?

– Discussion of ease of change versus likely effectiveness

– Who was / would be affected by change

Lessons and messages

– What changes occurred?

– If changes did not occur - why not?

– What were the benefits of patients?

– Lessons and messages - for your organisation

– Lessons and messages - for other organisations

– Were benefits sustained?

Guidelines for reporting more extensive quality research

SQUIRE guidelines

(Standards for QUality Improvement Reporting Excellence)

Publication guidelines for quality improvement in health care: evolution of the SQUIRE project 2008;17:Suppl 1

References

Bibliography software (Endnote library)

•Compile as you go

•Import from databases where possible

•Pros & cons of separate libraries per project or topic

Acknowledgements

• Participants

eg health providers

patients

• Colleagues

• Funders

Edit / proof read

Brevity & clarity – cut & slash

Language consistently UK or US?

Spelling, grammar, punctuation correct?

Ask colleague to sample

Re-circulate to co-authors

All must approve the final version

Check submission requirements

• Combined or separate files

• Possible referees

• Additional documents

� Conflict of interest

� Copyright

Submission

Obey instructions!

Include in your covering letter to Editor:

• What your research adds to what is already known

• Why their journal should publish your paper

Log your submissions

• Ensure journal acknowledges submission

Log:

• paper name & authors

• date submitted

• name of journal

• date rejected

• date resubmitted to new journal

• etc

In press

Once accepted

move from log to CV

Tardy journals

• Check probable decision date

• Use outlook or diary reminder if no response by that date

• (Politely) email to ask what is happening re paper

• If too long, consider withdrawing paper

Rejection!

Get over it! (fast)

Appeal?

Get over it! (fast)

Appeal?

Do not let it languish…

Resubmit quickly

• Useful comments from reviewers?

• Chose new journal (more realistic?)

• Re-write to fit new journal criteria / referees’ reports

Gourmet or fast food?

If too many rejections & / or taking too long, chose more lowly journal likely to publish

Got stuck?

Identify missing ingredient

Add to shopping list

Usual source

eg library refs

Special source

eg interloan

Colleague

Technical

assistance

Training eg stats

eg analysis