Quality improvement reports: a new kind of articleBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7274.1428 (Published 09 December 2000) Cite this as: BMJ 2000;321:1428
They should allow authors to describe improvement projects so others can learn
Education and debate p 1460
Today we publish our first quality improvement report (p 1460).1 It shows how a group from Paris managed to improve the management of pain in patients after surgery by switching them early from intravenous to oral acetaminophen. The report uses a structure (box) that we have copied with permission from the journal Quality in Health Care.2 One of the best ways to improve your journal—or anything—is to keep scanning your environment for good ideas and then copy them.
Those who work in quality improvement in health care have a poor record in publishing their articles. This may be because they are too busy to publish or because journals won't accept their submissions. But it might be because reports on improvement projects are hard to write and because the traditional structure of scientific articles (IMRAD: introduction, methods, results, and discussion) is unfriendly to such reports. Structure is the hardest and most important part of writing. You need a clear structure so that readers don't get lost: they need to know where they've come from, where they are, and where they are going. To be lost in a sea of words is depressing. Most readers who are lost simply give up. The beauty of the IMRAD structure is that it is familiar to both authors and readers and thus makes life easier for both.
Unfortunately the IMRAD structure doesn't seem to work well for improvement reports. There are often repeated cycles of measurement, change, further measurements, and further changes. Interventions are often multiple, and readers may learn as much (or even more) from the interventions that didn't work as from those that did. The context matters much more than in clinical research, and the methods and the strategies for change are usually much more important than the results—because they are generalisable in a way that the results are not. Even if authors can cram their messages into the traditional IMRAD structure they may fail to convey the messages that matter to their readers.
Structure of quality improvement reports
Brief description of context: relevant details of staff and function of department, team, unit, and patient group
Outline of problem: what were you trying to accomplish?
Key measures for improvement: what would constitute improvement in the patient's view?
Process of gathering information: methods used to assess problems
Analysis and interpretation: how did this information change your understanding of the problem?
Strategy for change: what actual changes were made, how were they implemented, and who was involved in the change process?
Effects of change: how did this lead to improvement for patients and how do you know?
Next steps: what have you learnt and/or achieved, and how will you take this forward?
The editors of Quality in Health Care developed their new structure and introduced it last year.2 They have since published two reports, 3 4 and authors and readers seem to like them. We will welcome submissions that use the structure of quality improvement reports. They will be peer reviewed in the normal way.