International Journal for Quality in Health Care 15:453-454 (2003)
© 2003 International Society for Quality in Health Care
EDITORIAL |
A conversation among friends
For the past ten years, working with my able Managing Editor Morag Teek, and Associate Editors Andrew Thompson, Heather Buchan, Joseph Ibrahim, Jorge Hermida and Klaus Piwernetz, I have edited this Journal. Guided and supported by the Chief Executive Officer of the International Society for Quality in Health Care (ISQua), Lee Tregloan, and the ISQua Board members responsible for the Publications Portfolio, Nancy Dixon and Heather Buchan, we have lived through exciting times—most notably the transfer of the Journal to joint-ownership by ISQua and the Oxford University Press (OUP) in 1998. From that date on, we have had support and guidance also from the experts at OUP, especially Mandy Hill, the Head of Science and Medical Journals in the Journals Editorial Department. Throughout, we have received valuable advice from an Editorial Committee of 30 individuals, all members of ISQua, drawn from around the world (the names of the current committee members appear on the title page of every issue). Most important of all, without the hundreds of authors and reviewers, each devoting many hours to their efforts, the Journal would not exist. So, after thousands of manuscripts submitted and reviewed and hundreds published, what has it all been for? What is all this activity about?From the author side of the enterprise, it sometimes feels as much a terrible test of endurance and self-esteem as of excellence in research. Yes, I have often been on the author side with other journals! I can testify that reviewers’ comments and editors’ ‘rejection’ letters can spoil one’s day! After months of data collection, analysis, writing and re-writing to reach perfection while keeping co-authors on board, it is daunting to find one has overlooked all sorts of problems that the reviewers immediately see. Worse still, they may disagree about the importance of one’s work! Why would anyone go through this grief? Is it just to build a record of publications in journals with the best impact factors and so ensure promotion?
The editors’ side can also seem fraught with challenges and difficulties. As the World Association of Medical Editors points out ‘The influential position of medical journals between public investment in research and public access to the fruits of this investment places a heavy responsibility on those who control what is published—medical journal editors.’ [1]. Will we be able to distinguish valid scientific results from flawed or misguided claims? Will we avoid the perils of conflict of interest and plagiarism? How will we find reviewers willing to volunteer their time and skills to provide fair and detailed critiques? Will our audience read anything that we publish? Why persist in this travail? Is it just to raise the Journal’s impact factor and so increase the number of submissions and so become more selective and so increase the impact factor still further and so sell more subscriptions?
I like to think of the Journal as an opportunity for conversations with friends. Authors and their colleagues want to communicate their ideas and their findings to others. Editors, of course, cannot be experts in every topic. So editors seek out people who are experts in the authors’ topic and ask them to review the manuscript. The reviewer’s role then is to advise the authors about their research—how to improve the way they conduct and present their work. Sometimes the reviewers will advise the authors ‘this isn’t really ready for you to share with others. Your communication will be better received if you work on this some more.’ The editor is the broker for this specialized conversation. Many authors do, in fact, see the review process this way. They comment that it is exciting to ‘meet’ reviewers who shared their enthusiasm for the topic and who gave advice about it for free. Not all conversations of course are equally productive or enjoyable. As in any substantive conversation, even among friends, sometimes the interchange gets heated! Many manuscripts, too, simply cannot find a place in the limited pages of any one journal.
There is more to medical publishing, however, than friendly conversation. If we shift our attention to a larger scale we see that a grander series of events is unfolding. We can picture this as an ecosystem. Let me elaborate this image a little. In an ecosystem, different species of plants and animals interact with their physical environment and each other to sustain a complex organization. The system is not static, but subject to change. Over time, a small alteration in one part of the ecosystem may trigger a set of complex interactions that transforms the system in an irreversible way. The initial change may be tiny, but sufficient to disrupt the exquisitely detailed connections within the ecosystem and so to launch massive change. So intricate are the interconnections that we can seldom unravel a sequence of causes and effects. We cannot break down the ecosystem to study such causes and effects, because the behavior of the whole cannot be predicted by summing the behavior of the parts. Notice that some species may be minutely adapted to fit a particular niche in an ecosystem. At a time of major change, these species must adapt to survive.
Now think of authors, reviewers, editors and publishers as inhabitants of the medical scientific ecosystem. The interactions between these agents influence and may change each other. These changes may trigger new research and new activities, which in turn generate new knowledge. Sometimes the snowball effect of the law of increasing returns leads to irrevocable change in our environment—and that change in turn creates reactions with far distant and major effects. Any one author or one paper is insignificant when seen on this scale. Seldom can we say that any one individual was responsible for this or that shift in thinking. Evolution in our environment depends upon every individual’s actions and interactions. The one certain thing is that change will occur over time. The papers that appear in this Journal ten years from now will seem to be part of a completely different and unforeseeable landscape. A highly specialized organism such as this Journal and its participants must adapt to such changes and evolve. Fortunately, the Journal will now be in the capable hands of its new Editor, Thomas Perneger. I shall watch its evolution with interest!
International Journal for Quality in Health Care, Harvard School of Public Health,Boston, MA, USA
Reference
- World Association of Medical Editors (WAME). Report of The World Association of Medical Editors (WAME): An Agenda for the Future. The Rockefeller Foundation Bellagio Study and Conference Center, Bellagio, Italy. January 22–26, 2001. http://www.wame.org/bellagioreport_1.htm.
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