How to write an abstract. Fiona Moss and Duncan Neuhauser Paris April 2014

Background:1 There is a lot of good QI work “out there” It might help if shared/communicated Writing is way of communication Publication would help others Much of what is written up as “audit” is boring and uninformative

Aims of this session Describe Quality Improvement “in action” through using a structure for writing about QI To show that writing can help your thinking Learn how to translate achievements into words

Objectives of this Session To understand some of the basics of QI To encourage you to plan and complete your QI project To learn a process for writing about your work To encourage you to “write it up” for publication

Why bother to write well? Writing is one of the communication skills. To communicate your message with clarity and accuracy To engage and stimulate your readers To help you reflect on your work

RED

SYSTEM

BUDWEISER

SET

Getting down to writing: Story Structure (Style)

Quick foray into matters of style! “Good prose is like a window pane…” Short sentences Nouns and verbs! Avoid purple prose

Journalists’ first lesson (borrowed from Kipling’s serving men) What, why and when and How and Where and Who

George Orwell (1) “[Language] becomes ugly and inaccurate because our thoughts are foolish, but the slovenliness of our language makes it easier for us to have foolish thoughts.

George Orwell (2) Never use a metaphor, simile, or other figure of speech which you are used to seeing in print. Never use a long word where a short one will do. If it is possible to cut a word out, always cut it out. Never use the passive where you can use the active. Never use a foreign phrase, a scientific word, or a jargon word if you can think of an everyday English equivalent. Break any of these rules sooner than say anything outright barbarous.

Strunk and White Make the paragraph the unit of composition: one paragraph to each topic As a rule start each paragraph with a topic sentence; end it in conformity with the beginning Omit needless words Use the active voice

Paragraphs Topic sentence: what’s the idea you want to talk about? Elaborate on that idea Final sentence: round off the point you are making…. …and, ideally, form a link to the next idea

Read this: can you re-write this? Data obtained from the audits were analysed. Significant problems in preoperative and postoperative care were identified. Review of preadmission processes identified significant delays in transfer of patients from the emergency department to the two wards with alternating admissions. Delay in physician input was identified and the high level of mortality was unacceptable. There was a need within the hospital for a more proactive culture in the management of this situation.

Is this better? Our audit showed problems in preoperative and postoperative care with an unacceptably high mortality rate. Patients were slow to be admitted from the emergency department and physicians did not assess them promptly. We urgently need to find better ways of looking after this vulnerable group of patients.

Getting down to writing: Story Structure (Style)

Your story: Recall quality improvement work that you would like to share Write about it in just paragraph or two. Get it down to its “basics” – bullet points OK here

Instructions for ”readers/listeners” Listen very carefully….(!) Do you understand what the “story” is? What is missing that would help you understand? Write down any questions

Best of British –our tabloids - 1 Amy stole coke from Kate’s bag Boozy Brits give NHS a sore head Experts admit their forecast is washout How a broken tumbler cost one pub £18,000

Best of British – our tabloids– 2 Asda withdraws corned beef after 50% nag traces 10 teens in hospital on mind-bending party drug rocket fuel Jobs gloom leads to a baby boom PM: no job… then no benefits for you

“Readers/listeners” Now write your “Sun headline”

Authors Is that “Sun headline” a correct summary?

Authors now revise your bullet points into paragraph(s) Listen to the play- back/questions from your readers. Be clear about “What is the ‘story’?” Revise your brief description of your quality improvement work Make sure that you make the main messages clear.

Getting down to writing: Story Structure (Style)

Quality improvement papers: using a structure Structure can help the process of writing Essential for some journals Ensure that use the structure appropriate for the journal and article type Otherwise, useful for structuring thoughts

Quality improvement papers: using a structure Structure provides a logical sequence Contains “the story” within it Setting objectives for the paper is important Continuity between sections is important Link back to objectives throughout End should connect with beginning i.e. “discussion” must relate to “introduction”

Structure for QI work should reflect : Cyclical nature of QI Process of assessment Process of gaining understanding of organisational issues Complexity of organisational change Steps required for organisational change Processes of review and re-assessment

Structure for quality improvement reports The context Outline of problem (patient centred) Key measures of improvement Process of gathering information about problem Analysis and interpretation – how the information helped your understanding of the problem/solution Strategy for change; implementation of change Effects of change - reassessment Next steps - lessons learnt – messages for others

Convincing others Narrative important but not all Measurement and data are essential Need data that is robust But clearly QI is not RCT Beware spurious use of statistics How do you know your change is improvement

Now…. Take the 2 paragraphs you wrote about your quality improvement report, remembering the input from your “reader” Revise it using the structure provided…..

Your structured abstract Does this help? Could you convey your messages using this structure? What are the problems? Could you write your story for your reader?

Publishing QI work

What type of paper reflects your work? A quality improvement report? A research paper? A review? A “How To Do It?” An opinion/view point? A letter? Etc etc etc.....

Quality improvement reports for publication Not necessarily completely original Must have a message for others Be explicit about context If change has occurred - how did you manage it and sustain it ? Organisational changes - important Interpersonal interactions - important Real message may lie in difficulties Progress may not be linear Be clear about messages

Quality improvement reports: check essentials? Is it about improving the quality of care? Does it have a message relevant to improving the quality or safety of patient care? Does it describe changes that improve patient care? Is the evidence robust? Is the message generalisable? What is in it for others to learn?

SQUIRE guidelines

Squire Guidelines: Introduction Background knowledge Local problem Intended improvement Study question Methods Ethical issues Setting Planning intervention Planning study of intervention Methods of evaluation Analysis

Squire Guidelines: Results Outcomes –Nature of setting and improvement intervention –Changes in processes of care and patient outcomes Discussion Summary Interpretation Relation to other evidence Limitations Conclusions Other factors

Quality improvement papers: finding a structure Standard structure for research papers. “IMRaD” Introduction/Methods/Results and/Discussion Perhaps not a helpful structure for QI work

Introduction Back ground to the paper Makes the “case for” the need for the paper Should end with objectives of the paper Whole of rest of paper should be written to the stated objectives Objectives are the “thread of the paper

Methods Headed sub-sections Helps with writing (can be taken out later) Logical order Do not include results End with section “Data analysis” that outlines how you intend to use data to meet stated objectives as well as any statistical analyses

Results Headed sub-sections Helps with writing (can be taken out later) Logical order - start with demographics Must link to objectives Whole number with percentages in brackets x/y(n%)

Discussion Short “pithy” summary of main findings – must link to objectives Outline of clinical or other implications If appropriate compare results with other relevant work Outline limitations of work Reflect on possible future research