Quality improvement reports: a new kind of article
BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7274.1428 (Published 09 December 2000) Cite this as: BMJ 2000;321:1428All rapid responses
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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.
Competing interests: No competing interests
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
Competing interests: No competing interests
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.
Competing interests: No competing interests