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Organising a Manuscript Reporting Quality Improvement Or Patient Safety Research Downloaded from qualitysafety.bmj.com on January 31, 2014 - Published by group.bmj.com BMJ Quality & Safety Online First, published on RESEARCH14 May 2013 AND as REPORTING10.1136/bmjqs-2012-001603 METHODOLOGY Organising a manuscript reporting quality improvement or patient safety research Christine G Holzmueller,1,2 Peter J Pronovost1,3,4,5 1Armstrong Institute for Patient ABSTRACT While a useful manual, it does not discuss Safety and Quality, Johns Background Peer-reviewed publication plays the nuances of reporting quality improve- Hopkins Medicine, Baltimore, Maryland, USA important roles in disseminating research ment and patient safety research. 2Department of Anesthesiology findings, developing generalisable knowledge Published guidelines are available to & Critical Care Medicine, The and garnering recognition for authors and improve the reporting of quality improve- Johns Hopkins University School institutions. Nonetheless, many bemoan the ment and other health services–related of Medicine, Baltimore, 5 Maryland, USA whole manuscript writing process, intimidated by research. The Standards for QUality 3Departments of Anesthesiology the arbitrary and somewhat opaque conventions. Improvement Reporting Excellence & Critical Care Medicine, and Methods This paper offers practical advice about (SQUIRE) guidelines offer an informative Surgery, Johns Hopkins organising and writing a manuscript reporting University School of Medicine, checklist when describing quality improve- Baltimore, Maryland, USA quality improvement or patient safety research for ment studies, which often have interven- 4Department of Health Policy & submission to a peer-reviewed journal. tions that evolve over time and are Management, Johns Hopkins Results Each section of the paper discusses a context-dependent.6 Bloomberg School of Public — Health, Baltimore, Maryland, specific manuscript component from title, Whether clinical or quality improve- USA abstract and each section of the manuscript body, ment, research is conducted to observe or 5Johns Hopkins University School through to reference list and tables and figures— explain something unknown or to evaluate of Nursing, Baltimore, Maryland, explaining key principles, offering content an intervention’simpactonanoutcome.7 USA organisation tips and providing an example of Observational studies ask questions and Correspondence to how this section may read. The paper also offers a generate hypotheses, while evaluation Christine G Holzmueller, checklist of common mistakes to avoid in a studies test hypotheses. Randomised clin- Armstrong Institute for Patient manuscript. ical trials generally evaluate one therapy’s Safety and Quality, Johns Hopkins Medicine, 1909 Thames impact on one outcome, sometimes com- Street, 2nd floor, Baltimore, MD Peer-reviewed publication plays important paring to a placebo or an alternative 21231, USA; roles in disseminating research findings, therapy, most often controlling all other [email protected] producing generalisable knowledge and care. Quality improvement is messier Received 17 October 2012 garnering recognition for authors and because it involves changing human behav- Revised 20 March 2013 institutions. Yet, writing is rarely taught iour in practice, testing and evolving inter- Accepted 2 April 2013 in medical school. In a 1985 survey, only ventions over time, developing theories 11 of 100 American medical schools that explain how the intervention relates to offered some type of composition course improved outcomes, incorporating how for biomedical research papers.1 Pierson2 local context influences implementation studied manuscript rejections and found and, often, evaluating performance. that one of the major reasons was poor The SQUIRE guidelines help authors preparation (eg, over interpretation of untangle the mess of quality improve- results, text difficult to follow). ment work. Nonetheless, we repeatedly Many healthcare professionals have hear colleagues and mentees bemoaning trouble organising and writing a research the whole manuscript writing process. manuscript. One editor-in-chief described They have trouble determining what to it this way: ‘Their scholarly and creative include and how to frame their paper, ideas and insightful data interpretation seeking practical guidance and heuristics. To cite: Holzmueller CG, often seem to get lost in the translation This paper offers practical advice about Pronovost PJ. BMJ Qual Saf ’3 Published Online First: [please from brain to page. This quote begins the organising and writing a manuscript include Day Month Year] foreword for the AMA Manual of Style, reporting quality improvement or patient doi:10.1136/bmjqs-2012- which is a comprehensive guide to writing safety research for submission to a peer- 001603 and publishing biomedical research.4 reviewed journal. Holzmueller CG, et al. BMJ Qual Saf 2013;00:1–9. doi:10.1136/bmjqs-2012-001603 1 Copyright Article author (or their employer) 2013. Produced by BMJ Publishing Group Ltd under licence. Downloaded from qualitysafety.bmj.com on January 31, 2014 - Published by group.bmj.com Research and reporting methodology PLANNING A MANUSCRIPT We have organised our manuscript into six distinct The four phases of a manuscript include planning, parts: title, abstract, body, reference list, tables and writing, submitting and revising. We cover the first two figures, and acknowledgements. phases. A recent article nicely lays out the last phase, revising your manuscript following peer-review com- TITLE AND ABSTRACT ments.8 This section is important, please read it carefully. The title and abstract are prominent parts of a manu- In the planning phase, define your audience and script. Both sections are the first, and in some cases, choose an appropriate journal. Understanding your the only content the editor and journal readers will audience will guide the level of detail you provide (eg, peruse. Your title should grab the readers’ attention, definitions for terminology). Look at the journal’s like a news headline, while providing an informative scope and article categories to ensure your research description of the study. Try to mention the interven- fits. Once you have chosen a journal, read the author tion, setting, patient population, outcome measure instructions for the word limit, specific formatting and study design. For example, ‘Patient information instructions, and required content and forms (eg, dis- sheet improves inpatient care during Radiology closing competing interests). Also, draft the order of testing.’ Notice that this title is concise and is not a authorship, complete a literature search related to wordy sentence. your research topic, assemble tables and figures of The abstract is a snapshot of your study and should your data and outline your paper. inform and persuade the editor and audience to read Outlining can help organise your thoughts and the full manuscript. Content that will clearly illustrate manuscript content, offering a double check for com- your study includes the objective, study design, popula- plete and consistent information. For instance, if you tion, setting, intervention, primary outcome measure describe a survey of laboratory technicians and nurses and the method of analysis, important findings and in the methods, report the response rates by job cat- brief conclusion. Before you draft the abstract, read the egory and the survey data in the results. Head your author instructions and follow their structure and word outline with a thesis statement to avoid scope creep length. Avoid abbreviations unless it is a unit of measure and remain focused on the paper’s main message. (eg, mg for milligram) and exclude references. Your abstract must make sense and not read as WRITING A MANUSCRIPT random content grabbed from your manuscript and Writing the first draft of your manuscript is different plunked into subheadings. For example, if you report from writing a novel, in which you start at the begin- that ‘92% of radiology technicians perceived the ning and proceed to the end. A research paper has dis- patient information sheet was useful’ in the results, tinct sections (abstract, introduction, methods, results, then describe the mechanism of data collection (eg, discussion) that fit together like a jigsaw puzzle to tell survey, interviews) and sample size in the methods. your story. Write each section separately. Read some published abstracts to guide your writing. We can recommend several strategies to make the Whether you write the abstract before or after the writing process less onerous. You can write the sec- main body of your manuscript is a matter of prefer- tions in the following order: methods, results, intro- ence. If you write it first, remember to revise it when duction, discussion and finish with the abstract. the manuscript is complete to ensure consistency of Alternatively, write the abstract and create the tables content. As a general composition rule, write in the and figures first, write the methods and results past tense when discussing what you did or found and together next, then write the discussion and finish in the present tense when describing what is known with the introduction. You could also write the (eg, the evidence). methods during the planning and implementing phases of the study. Writing your paper concurrently MANUSCRIPT BODY with the work is invaluable because it helps produce a Your manuscript body is a nonfiction story, with a more accurate account of what occurred and clarifies beginning (Introduction), a middle
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