By Denise Goodman, MD, MS, FCCM

Many of us practice in an academic environment, where advancement requires scholarly productivity. In addition, for those who may receive a mission-based incentive bonus, the research mission includes publication in peer-reviewed journals. At the same time, many of the critical activities we perform related to hospital operations and financial health, such as status determinations, peer-to-peer results, and provider education, do not neatly fall into academic categories of productivity or achievement. One solution is to consider where the two parts of our job intersect, and how we might leverage operational tasks into peer-reviewed papers. 

How is a busy physician advisor going to do this? I think it breaks down into 3 steps:

1. What types of projects, programs, or initiatives lend themselves to publication? 
2. What strategies might we use to find time in our schedules to do this and ensure success? 
3. How will we disseminate our findings? Who is the audience, and how do we reach them? 

First things first. Nearly any initiative one undertakes may lead to a publication, presentation, or scholarly product. For instance, nearly any quality improvement project with clinical implications (readmission reduction, creation of an intermediate care unit, or clinical pathways, etc.) might be amenable to publication in a clinical journal related to your specialty (internal medicine, pediatrics, hospital-based medicine, family medicine, and the like). There are specific guidelines for how to organize, structure, and report quality improvement work and the good news is that these guidelines are not just for organizing the paper at the end of the project. They form useful roadmaps for how to structure your intervention from the beginning, ensuring that you have not inadvertently forgotten important details and steps. The most common guideline for quality work is SQUIRE (Standards for QUality Improvement Reporting Excellence). This can be found at the Equator Network webpage or at the SQUIRE site. 

If you need to gather baseline data or extensively review literature, for instance comparing the performance of 2 scoring systems or looking at trends over time (particularly if these reflect multiple sites), consider whether this could be expanded to original research. Depending on the question you are asking this sort of work might be appropriate for a clinical journal or for a hospital operations journal. 

Perhaps the biggest hurdle is finding the time and means to turn one’s work into a manuscript. It can seem daunting, and finding time may be a challenge. In addition, writing manuscripts may not have been a principal focus of one’s career. There are a few ways to tackle this. One is to engage a partner. For instance, there may be a young physician looking to advance his or her academic career – let them take first crack at the manuscript. They will rightfully be first author, and you may be further down the author list, but if you have something important and useful to say to your peers then it deserves to be out there. If data analysis and visualization are a challenge, there may be resources from your hospital’s data team. Another approach is to volunteer to give Grand Rounds – just the effort to review the project, organize your thoughts, and compare to similar published initiatives goes a long way toward compiling the perspective and materials to inform a manuscript. 

Not all work needs to be original research. I worked with a team on improving our discharge efficiency and in the course of that work we amassed a substantial library of approaches used at other institutions. One of the members of our team developed that into a review for Hospital Pediatrics entitled “The Perfect Discharge: A Framework for High-Quality Hospital Discharges” which uses the National Academy of Medicine quality domains to frame the attributes of an ideal discharge process. 

So, now you’ve done the work and organized your thoughts, where can it go? The most important thing is to ask yourself who you wish to be the audience. This may be clinicians in the field, C-suite leaders, or others. We’ve identified common academic journals, and also the strategy of giving a Grand Rounds as a form of dissemination. Physicians may be less familiar with journals used by hospital administrators, so ask your leadership what they read. For instance the Journal of Healthcare Management is the official journal of the American College of Healthcare Executives. The Healthcare Financial Management Association publishes HFM. There are numerous quality journals, including the Joint Commission Journal on Quality and Patient Safety, BMJ Quality and Safety, and others. Similarly, there are a number of informatics journals if your solution centered on an electronic health record solution. If you were involved with provider or trainee education, education journals or online education portals may be most appropriate.

So be inspired! We do important work and there are numerous opportunities to share the knowledge gained and, in so doing, to also contribute to the scholarly mission of our institutions.