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EDITORIALS: Richard Smith Quality improvement reports: a new kind of article BMJ 2000; 321: 1428 [Full text]

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The global village

John Hopkins   (15 December 2000)

Quality improvement reports: the king's new clothes?

Jonathan D Beard   (9 January 2001)

Being 'too busy to publish' is not an excuse

Adam Jacobs   (12 January 2001)

The global village 15 December 2000
John Hopkins, GP Darlington Send response to journal: Re: The global village	Dear Dr Smith, Many villages have their own newspaper.These are different in quality from national papers; more colloquial and accessible to their audience. bmj.com has created its own global community. In reaching a wider audience, Internet journals need a less formal structure that can be read by people not from a scientific background and those for whom English is a second language. This new kind of article is a good illustration of how that should be done. Of course, taken to its logical conclusion this approach leads to the review style exemplified by Scientific American. However, the Internet allows the best of all worlds. In the same way that a melody hovers above the base line, scientific data can be folded into articles through hypertext links while the main thread of the argument is in the text of the essay. Rather like Editor's Choice in fact ! Yours sincerely, Dr John Hopkins
Quality improvement reports: the king's new clothes? 9 January 2001
Jonathan D Beard Send response to journal: Re: Quality improvement reports: the king's new clothes?	EDITOR - In his editorial, Richard Smith welcomes Quality Improvement Reports (QIR) as a 'new kind of article' (1). However, I couldn't help but notice the similarity between QIR and Clinical Audit. Both involve repeated cycles of measurement, change and further measurement. The authors of the article, to which Smith refers, actually use the word 'audit' in their table legend (2). To add to the confusion, another strategy called Action Research, also employs a cycle of repeated observation and intervention (3). The only difference here appears the use of qualitative rather than quantitative research methods (4). How have different descriptions of the same intuitive process of quality control arisen? It seems that various groups of health- care workers feel the need to develop their own brand of the same methodology. Thus doctors use Clinical Audit, nurses employ Action Research and health-economists have now developed QIR. A search of the literature reveals the striking similarities between these three methodologies. Depressingly, each group appears reluctant to acknowledge their similarities as not one article (until this letter) has compared them directly. I welcome alternatives to the traditional IMRAD structure of scientific articles. However, I make plea for the editors of medical journals to agree an epistemology for alternative research strategies. We must ensure that all research, including audit, is performed and reported in a rigorous and transparent way (5). Better definitions and recognition of similarities, where they exist, would help this process. Jonathan D Beard Senior Editor, European Journal of Vascular and Endovascular Surgery, Sheffield Vascular Institute, Northern General Hospital, Sheffield S5 7AU Competing interests: None 1 Smith R. Quality improvement reports: a new kind of article. BMJ 2000; 321: 1428. 2 Ripouteau C, Conort O, Lamas JP, Auleley G-R, Hazebroucq G, Durieux P. Effect of multifaceted intervention promoting early switch from intravenous to oral acetaminophen for postoperative pain: controlled, prospective, before and after study. BMJ 2000; 321:1460-3. 3 Malterud K. Action research - a strategy for evaluation of medical interventions. Family Practice 1995; 12: 476-81. 4 Greenhalgh T, Taylor R. How to read a paper: papers that go beyond numbers qualitative research). BMJ 1997; 315: 740-3. 5 Mays N, Pope C. Qualitative research: rigour and qualitative research. BMJ 1995; 311: 109-12.
Being 'too busy to publish' is not an excuse 12 January 2001
Adam Jacobs, Director Dianthus Medical Limited Send response to journal: Re: Being 'too busy to publish' is not an excuse	Smith suggests that one possible reason for the poor publication record of those working in quality improvement may be that 'they are too busy to publish'. This is not a valid reason for not publishing. If they were too busy to fill in their tax returns, they would no doubt ask their accountants to do it for them. If they are too busy to write up their research, then they can engage the services of a professional medical writer to do it for them. Of course, this requires some extra budget, as medical writers do expect to be paid. But the cost of writing a manuscript is tiny compared with what is spent on doing the work in the first place. It seems a terrible waste if much money is spent on a worthwhile quality improvement project and the results are not then made available to the wider community. Anyone looking for a medical writer might like to start at the website of the European Medical Writers Association ( www.emwa.org), which has a list of freelance medical writers. There are also many medical communication agencies which can take on this kind of work. Competing interests: I am a medical writer.