How to write about quality and safety and get published

Mary Dixon-WoodsDepartment of Health Sciences

University of Leicester

Decide on your story• What is the story you want to tell?

• Write the abstract first – but keep writing it over and over and over

• Can you explain the story clearly?– Imagine you are being interviewed on live TV

What’s your story?

Where is the best place to tell your story?

•

Medical/health journals

– Good for exposure– Helpful for healthcare professional careers– Often short word limits, can be a bit frustrating for

some kinds of papers– Decide between specialist/generalist journals

Specialist/generalist health journals

• Big, high impact journals (NEJM, Lancet, JAMA etc)

• Speciality-specific journals (e.g. Pediatrics, Anaesthesia, Journal of Advanced Nursing, Journal of Clinical Pharmacy and Therapeutics)

• Quality and safety journals (e.g. BMJQS, Implementation Science, Joint Commission Journal on Quality and Safety...)

Where is the best place to tell your story?

• Social science journals

– Good for credibility– Can be intellectually satisfying if you are a social

scientist– Very demanding to write, long word limits– Needs theoretical sophistication– May be more limited in impact

Choosing a journal

• High impact/high status?

• Indexed on right databases?

• Going to reach your audience?

• Right requirements in terms of your story?

• Reasonable time to decision and publication?

Be aware of your audience• If medical/health audience make sure there is a

key set of practical messages

• If social science audience need to demonstrate mastery of theory

• If in doubt, explain concepts

• Always prioritise clarity

Fit the structure to the study type

• IMRaD is the basic structure for most health journals

• Guidelines cover many study types (e.g. CONSORT for clinical trials) http://www.consort-statement.org/

• http://squire-statement.org/ for quality improvement reports

Don’t forget the abstract

• Often given little time or effort by authors• But the busy editor is using it to screen

likely candidates• It also sets the tone for the busy referee• And it may be the only bit of your paper

that’s publicly, freely accessible• So work hard on it!

Structuring a paper: introduction

– Intrigue the reader. Set up a problem you are going to solve.

– Don’t go on too long – get to the point quickly. And don’t give a standard, boring introduction that everyone has read before.

– Give us• Something general about the importance of the

overall topic area.• Introduction of the particular content or problem

being addressed by this particular paper• Statement of precisely the purpose or research

question for the paper.

Introduction: Making the story work

• Don’t just summarise previous literature

• Get hold of your voice and make that literature work for your story

• There is no point in even mentioning literature unless it contributes directly to your story

Structuring a paper: Methods and Results

• Methods

– Clear, explicit, honest and accurate account.– If you use technical terms, make sure you

understand them and only cite literature you have read and understood.

• Results

– Use subheadings, tables, boxes as appropriate– Be coherent and concise– Generally don’t offer commentary at this stage in

health journals

Structuring a paper: Discussion

– Begin with a summary, highlighting the issues you want to draw out

– Acknowledge limitations

– Come to a conclusion, indicate policy or practice implications and directions for future research

Get the writing right• Good writing and good thinking are inseparable.

• Spelling, grammar, punctuation, and sentence construction all really matter. Getting them wrong damages your credibility.

• Avoid over-long, complex sentences. Avoid run-on sentences. Avoid using “however” unless you are absolutely sure you know what you’re doing.

. { ; & ? “ @! : “ , } ? ,]

Writing right• Use plenty of sign-posting, but try to do it in a

light-handed way. Use plenty of sub-headings, even if you end up deleting a lot of them later.

• Every para should contain a single idea, and transition seamlessly to the next.

• Make points once. Don’t keep repeating them.

Writing

Right

Structure, structure, structure• Organising your material into a coherent

narrative is the biggest challenge

• Be ruthless – cut, cut, cut

• Only include stuff that works for your story

• Maintain a voice that is consistent throughout.

Be prepared to change and change again

• May start off writing something but it mutates into something else

• Constant redrafting

• Keep coming back to abstract

• Try getting story down to bullet points

Working in a team• Fraught with challenges

• Decide on provisional authorship up front, but be prepared to revise

• Different models– Strong leader– Federal (section-based)

Working in a team• Make sure everyone sees and agrees final

version

• And agrees with any revisions subsequently

• Agree things like statement of contributorship

Authorship and contributorship

• International Committee of Medical Journal Editors (ICMJE) http://www.icmje.org/

• Good idea to describe every author’s contribution, even if not required by the journal

Preparing a submission• Make sure you address journal-specific

requirements – References in correct system– Comply with any journal requirements– Delete hangovers from previous submissions

• Make sure you get acknowledgements right

• Keep a note of when you submitted it; ok to start hassling editorial assistant after about 3 months – but do it nicely

Be prepared for harsh words and rejection

• Major medical journals reject ~95% of submissions– Sometimes within hours of receipt

• Major social science journals reject about 80% and up

• Only appeal if you really are sure of your grounds

• Most articles are rejected three or four times before getting published somewhere

Rejected

Referees’ reports• May seem very hurtful, esp first few times

• Try to move beyond emotional reaction

• Sometimes seem incompetent or perfunctory

• Often very helpful

• Sometimes (often?) the reports contradict each other

Responding to referees’ reports

• Amend your paper to address the points raised, as appropriate

– Don’t feel you have to do everything they suggest

• Give a point-by-point explanation – helpful if you number this. Indicate if there’s anything you would give way on.

• Be respectful – make displays of deference

Next stages• If rejected, think about where to go next

• If accepted, be very cooperative with copy-editing and proofing

• Check re putting a pdf into your institutional archive

• Put publication details on your website etc

• Check if press office (either journal or your institution) would be interested

Things that go wrong• Team fights over where to send paper

• Team cannot agree draft of paper

• Team cannot agree order of authorship

• You have a renegade on the team

• Someone wins a point but then it gets rejected because referee supports other position

Plotting an academic paper

The 7 step programme1. Problem2. Desire3. Opponent4. Plan5. Battle6. Knowledge7. New level

1. Problem• Show that there is some issue that really needs

tackling

• Introduce it in an attention-grabbing way if you can

• Make it an interesting problem

– Show how it’s obstructing the achievement of important goals

– Link it to a policy or practice objective– Show how it affects people’s lives

2. Desire• Your desire is to put the problem right

• Formulate your desire as a clear research question

• At the early stages of a paper you may be working up towards posing this question

• So use your literature strategically

A good research question

• Is clearly stated

• Is well defined (and will have defined its terms in the lead-in phase)

• Is oriented to solving an empirical or theoretical trouble

3. Opponent• The thing that is standing in your way of

resolving the problem is (usually) that other research has failed

• There is a gap in the literature

• And you’re the one to fill it – you’re the (wo)man with the plan

Using the literature• Everything you do has to work to establish the

problem, desire and opponent

• DO NOT simply list studies and what they say– this is very boring and doesn’t help you build your

argument

• DO NOT start sentences with the name of the author– e.g. “Woodrow et al state that most patients avoid

taking tablets that are difficult to swallow.”

Marshall the literature effectively• Identify ways in which the literature can be

organised

• Generate your own labels for these if needed

• Use devices such as numbering

– Four major approaches to explaining non-compliance with infection control can be distinguished.

– One dominant way of understanding non-compliance is to examine behaviours. In this article, we propose an emphasis on values instead.

4. Plan• State your aims clearly at the end of the

Introduction, having convinced us there’s really a problem

• Now outline your plan

• This should be a good plan that is well suited to addressing the problem

5. Battle• The battle is your efforts to implement your plan

• It won’t always go perfectly

• So show how well what actually happened matched your plan

– Report response rate and the characteristics of who ended up in the study

– Tell us anything that might be relevant to understanding plan implementation

6. Knowledge• This is your results

• Present them authoritatively and clearly, in a logical sequence – build a plot and keep us interested

• Put things in tables if needs be, but then don’t repeat the material again the text. And don’t say “Table 1 reports…”

7. New level• This is your Discussion

• Start by restating your main findings

• Reflect on the new level you’ve reached as result of your plan and battle to address the problem

• Link to what is already known

• Acknowledge the limitations

• Tell us about the implications (what needs to be different now?)

• Say what more needs to be done to sort the problem

The authorial voice• This needs to be constantly present

• But not clumsy – you need to be confident and in control of the material, steering us towards your argument

• Be assertive, be in charge, make us think you’re worth listening to

• Use devices such as explaining what your argument is at the beginning– “we will argue that non-compliance is best understood

as a problem of legitimacy, rather than one of unprincipled cognitive lapse”

Other plot devices

• Use a short, authorial interjection from time to time– “All three of these approaches are deficient in the way

they conceptualise non-compliance”

– “Soandso’s (1993) approach offers perhaps the most thoroughly informed critique of the ‘cognitive lapses’ tradition”.

– “Soandso’s proposal does little to address the problem that ‘cognitive lapses’ explain only a small proportion of non-compliance.”

Sleights of hand• When you need to acknowledge that there are

lots of ways of thinking about something, but don’t want to go into them all

– “Among the many approaches to conceptualising non-compliance, those that address professionals’ values are most persuasive.”

– “Non-compliance escapes straightforward definition. For purposes of this study, we will adopt that used by Soandso, in her influential analysis.”

The signs of an amateur• Saying “in 1993, Soandso said that..”

• Using ‘dollops’ of literature

• Claiming the work is much more important/significant/original than it really is

• Describing, not conceptualising

• Being too passive

Questions?