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One
of our recurrent themes is that medical journals
are failing to communicate to anyone other than an
anointed few. So, when the journal Quality and
Safety in Healthcare advertised in July 2004
for a new editor, to make academic research
'relevant and accessible', we put in an
application. Our plan was based on the conclusion
that we need to take radical action if we are to
achieve this praiseworthy goal. Needless to say,
the job went elsewhere, but we publish the proposal
here in the hope that someone some day will be in a
position to put these ideas into practice.
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QSHC: a
proposal
What are the strengths
of QSHC?
QSHC publishes articles of a high academic
standard. It has an excellent reputation and has built up a
strong and loyal international following. It deals with
topics that are timely and important.
Where is the
problem?
The weakness is that relatively little of this
high quality information seems to make the move out into
health care practice.
In some ways this is not surprising, and is a problem
shared by all specialist journals. They were originally set
up to communicate advances in knowledge, but over the past
few decades this function has started to take second place
to that of validating science (and assigning ownership and
status). The needs of readers have been neglected by an
over-emphasis of the demands of authors.
There have been several attempts to break out of this
situation, usually by introducing more reader-friendly copy.
Such attempts generally fail, thanks to a mixture of tight
resources, lack of editorial skills and the attitudes of the
authors, who do not appreciate attempts to make their copy
more readable. (A recent short-lived experiment in
QSHC was a good example of this.)
What is the
solution?
I propose a two-tier approach that will allow us
to separate the validation of science from its
dissemination. This will be achieved by putting the original
papers on the web, and using a transformed paper journal to
publicise these findings.
(1) The electronic journal. The
goal of the electronic journal will be: to make high
quality papers available to the academic community as
quickly as possible. After a tight original selection, a
small number of articles will be sent out to peer review.
Those that are selected will receive light technical
editing, and then be posted onto the website. (Since the
papers will be only a small part of the added value
offered by the journal, there seems to be no commercial
reason why these should not be open access, subject to
company policy.)
(2) The paper journal. The goal of the
paper journal will be to: communicate new findings in
health care quality and safety to health professionals
who are in a position to implement them. The publication
would be smaller (24-36 pages) and distributed quarterly.
Its format would be that of a well produced magazine,
with well written articles from skilled writers. There
would also be editorials written by academics (and
usually heavily subedited), summaries of existing
knowledge and useful information, letters and submissions
from readers, and the abstracts of all papers published
on the website in the last three months.
If the journal is to have a real international impact
with the paper-based publication, we would have US and
European editions.
How would we ensure
that academics continue to
contribute?
Ensuring a continuing supply of high quality
papers is essential to the continuing success of QSHC, and I
plan to do this in two ways.
(1) Increase the impact factor.
Sadly this is the main determinant of journal choice for
authors, and climbing the league table will be a
priority. Fortunately the evidence shows that proactive
dissemination increases citation, and I am confident that
the paper-based publication, plus a constant flow of
press releases, will achieve this objective.
(2) Encourage submissions. High quality
original papers will be our core product, and I have
considerable experience in helping people to produce
these. It is clear to me that we can do much more to
encourage writers at an early stage, and I would pilot an
'accelerated writing programme' under which writers would
submit messages and protocols at an early stage. We would
then help them to produce the article within a short
period of time (say 4-6 weeks) using specially produced
distance learning material.
Will this compromise
the 'scientific integrity' of the
journal?
Separating the functions of validation and
dissemination should overcome any feeling among contributors
that the publication is moving down market. As further
reassurance that we take quality seriously, I would like to
consider ways of introducing tighter controls, perhaps by
random inspection of data.
How would we make it
pay?
Producing a paper-based journal with high
production values requires investment. I appreciate that
realistically this can only be achieved by reallocating
existing income. This can be done by reducing the size and
frequency of the paper-based journal, and if necessary by
other methods such as earlier rejection, less aggressive
technical editing, and fewer 'advisory' meetings.
Tim Albert
September 2004
18.11.04
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