Instructions for Authors

For guidelines on BMJ Journals policy and submission please click on links below.
Manuscript Formatting
Editorial policies
Patient consent forms
Licence forms
Peer Review Process
Online First process

Editorial policy

BMJ Quality & Safety (formerly Quality & Safety in Health Care) is a leading international peer review journal in this growing area of quality and safety improvement. It provides essential information for those wanting to reduce harm and improve patient safety and the quality of care. The journal reports and reflects research, improvement initiatives and viewpoints and other discursive papers relevant to these crucial aims with contributions from researchers, clinical professionals and managers and experts in organisational development and behaviour.

The journal covers:

• the development and integration of quality and safety initiatives into routine practice.
• experience of improving practice in all sectors of health care services.
• the influence of management and organisational learning on the quality and safety of clinical care.
• the views of consumers and their role as promoters of improved quality and safety in health care.
• research relevant to health care quality and safety from a wide range of relevant sources including non-medical domains

BMJ Quality & Safety aims to contribute actively to the debate about the quality and safety of health care by exploring subjects and ideas (from both routine clinical and managerial practice and research) which concern and inform this debate and which focus on real benefits to patients.

The journal attempts to handle the review process and publication as expeditiously as possible. The review process is usually completed within 4 weeks (mean 20 days), but can take longer in some instances.

Open access/Unlocked articles

Authors are able to make their articles freely available online, immediately on publication, for a fee, using the Unlocked service. This service is available to any author publishing original research in a BMJ Journal for a fee of £1,200(+VAT)/€1,775 (+VAT)/$2,220.

Article types and word counts

• Original articles
• Viewpoints
• Systematic reviews
• Narrative reviews
• Research and reporting methodology
• Short reports
• Editorials
• Innovations in Education
• History
• Book reviews
• Correspondence
• Point-Counterpoint
• Quality Improvement Reports
• Guidelines for reporting more extensive quality research
• Supplements

The word count excludes the title page, abstract, tables, acknowledgements and contributions and the references.

Original articles

Original Articles report research and studies relevant to quality of health care. They may cover any aspect, from clinical or therapeutic intervention, to promotion, to prevention. They should usually present evidence indicating that problems of quality of practice may exist, or suggest indications for changes in practice, or contribute towards defining standards or developing measures of outcome. Alternatively, they should contribute to developing approaches to measuring quality of care in routine practice. The journal is interprofessional and welcomes articles from anyone whose work is relevant, including health professionals, managers, practitioners, researchers, policy makers, or information technologists.

Word count: 3000-4000 words
Structured abstract up to 275 words in length
Tables/Illustrations: up to 5 tables or illustrations; appendices that present additional methodological details or other relevant materials that may be of interest to readers can also be included with the intention of aiding peer reviewers or providing them as online material for interested readers

Viewpoint

Essays presenting opinions or considering controversial issues related to patient safety or healthcare quality.

Word count: up to 2000 words, with no more than 2 Tables/Figs and fewer than 20 references

Systematic reviews

Systematic reviews, whether qualitative or quantitative (i.e., meta-analyses) should conform to the same guidelines outlined above for Original Research (Word count: 3000-4000 words or less, structured abstract of 275 words or less, and up to 5 Tables/Figs). Detailed search strategies and other supplementary materials will be considered for inclusion as online-only appendices.

Narrative reviews

We will consider narrative reviews of general topic areas within patient safety , as opposed to structured, systematic reviews that address the effectiveness of specific interventions. E.g., an overview of the state of the science in teamwork training or assessments of patient safety culture. Narrative reviews can also address methodological topics, such as the use of ethnographic methods in patient safety research or a primer on run charts.

Authors considering writing a narrative reviews are advised to email the Editor (kaveh.shojania{at}utoronto.ca) to confirm the suitability of the topic and ensure that it does not overlap too substantially with another review already in preparation.

Word count: up to 3000 words

Research and reporting methodology

Articles that aim to advance research methodology or reporting standards related to patient safety and quality improvement. These articles are distinct from Primers or How to type articles on meant to provide a useful resource for general readers (such reviews fall under the Narrative Review category above)

Word count: 3000 words or less

Short reports

Shorter reports of original research or implementation efforts , similar to Research Letters in major general medical journals.

Word count: 750 words or less with no more than 2 Tables or Figures - can be up to 1000 words if only 1 (or no) Table/Figure

Editorials

Editorials commenting on articles published in the same issue of the journal are written or commissioned by the editors. Guidelines will be discussed in advance with invited authors, but generally the word length will be less than 2000 words, have no more than 20 references, and sometimes have 1 Table or Figure.

Innovations in Education

Articles that describe innovative approaches to imparting trainees or practitioners with concepts or tools related to quality improvement or patient safety. Articles that report a robust evaluation can have the same format as Original Research. Less ambitious reports should be less than 1500 words and have fewer than 20 references. For shorter reports, note that the literature already contains numerous descriptions of curricula for students and trainees. To be of interest, the curriculum and, or the evaluation should include some relatively novel element.

History

Biographical essays on important figures relevant to quality improvement or patient safety (as in the "Heroes and Martyrs" series, which now falls within this category), as well as other essays on important events or developments in the history of measuring or improving healthcare quality and patient safety.

Word Count: up to 3000 words.

Book Reviews

Authors should contact the editor (at kaveh.shojania{at}utoronto.ca ) before writing a book review. The length should generally be 750-1000 words.

Correspondence

Letters in response to articles published in the BMJ Quality & Safety are welcome and should be submitted electronically via the website. Contributors should go to the abstract or full text of the article in question. At the top right corner of each article is a "contents box". Click on the "eLetters: Submit a response to this article" link. Some letters in response to an article may be published in the print version of the journal.

Letters relating to or responding to previously published items in the journal will be shown to those authors, where appropriate.

Word count: up to 600 words.
References: up to 5.

Point-Counterpoint

These are pairs of commentaries directly debating two sides of an issue or opinions or presenting differing perspectives on the same topic. They are typically invited, but we will consider suggestions from candidate authors. To suggest a topic for this series, briefly outline the topic to be discussed, including the two perspectives on the topic, and identify the lead author of the two pieces.

Word count: up to 2000 words, with no more than 2 Tables/Figs and fewer than 20 references (for each manuscript in the Point-Counterpoint pair).

Quality Improvement Reports

These have the same general guidelines as Original Research in terms of word length, but please note the detailed recommendations for content and formatting below.

Background

• Outline of problem, e.g.
• What was the problem that was identified for study (problem definition)?
• How was it identified?
• Why was it a priority?
• What were the stated objectives of audit?
• Outline of context (local and wider), e.g.
• Relevant details of local hospital/practice, etc
• Local internal organisation and structures relevant to the problem
• Wider context of the problem
• Outline of staffing arrangements, e.g.
• How staff work together.

Assessment of problems

• Detail of the approach taken with justification, eg
• Criteria based audit/critical incident/routine monitoring/TQM tools and techniques.
• Criteria, standards or guidelines developed, eg
• Who set them and how they were developed?
• Were they considered ideal or realistic?
• Measurement of problem, eg
• How was this done?
• Who did the assessment?
• How was it analysed?

Results of assessment/measurement

• How results were used to understand the problem, eg
• How results were put into local context
• Implications for improving the quality of care
• Implications for change

Strategies for quality improvement/change

• Feeding back information to relevant staff, eg
• How this was done?
• Why was this approach chosen?
• Who was included?
• What was their responses?
• Mechanism for change, eg
• What course of action was taken and why?
• Was this justified by the results and context?
• Discussion of ease of change versus likely effectiveness
• Who was/would be affected by change

Lessons and messages

• What changes occurred?
• If changes did not occur - why not?
• What were the benefits of patients?
• Lessons and messages - for your organisation
• Lessons and messages - for other organisations
• Were benefits sustained?

Guidelines for reporting more extensive quality research

SQUIRE guidelines (Standards for QUality Improvement Reporting Excellence)*

Item	Text section	Section or item description
	Title and abstract	Did you provide clear and accurate information for finding, indexing, and scanning your paper?
1	Title	(a) Indicates the article concerns the improvement of quality (broadly defined to include the safety, effectiveness, patient-centredness, timeliness, efficiency and equity of care)
		(b) States the specific aim of the intervention
		(c) Specifies the study method used (for example, "A qualitative study," or "A randomised cluster trial")
2	Abstract	Summarises precisely all key information from various sections of the text using the abstract format of the intended publication
	Introduction	Why did you start?
3	Background knowledge	Provides a brief, non-selective summary of current knowledge of the care problem being addressed, and characteristics of organisations in which it occurs
4	Local problem	Describes the nature and severity of the specific local problem or system dysfunction that was addressed
5	Intended improvement	(a) Describes the specific aim (changes/improvements in care processes and patient outcomes) of the proposed intervention
		(b) Specifies who (champions, supporters) and what (events, observations) triggered the decision to make changes, and why now (timing)
6	Study question	States precisely the primary improvement-related question and any secondary questions that the study of the intervention was designed to answer
	Methods	What did you do?
7	Ethical issues	Describes ethical aspects of implementing and studying the improvement, such as privacy concerns, protection of participants' physical wellbeing and potential author conflicts of interest, and how ethical concerns were addressed
8	Setting	Specifies how elements of the local care environment considered most likely to influence change/improvement in the involved site or sites were identified and characterised
9	Planning the intervention	(a) Describes the intervention and its component parts in sufficient detail that others could reproduce it
		(b) Indicates main factors that contributed to choice of the specific intervention (for example, analysis of causes of dysfunction; matching relevant improvement experience of others with the local situation)
		(c) Outlines initial plans for how the intervention was to be implemented-for example, what was to be done (initial steps; functions to be accomplished by those steps; how tests of change would be used to modify intervention) and by whom (intended roles, qualifications, and training of staff)
10	Planning the study of the intervention	(a) Outlines plans for assessing how well the intervention was implemented (dose or intensity of exposure)
		(b) Describes mechanisms by which intervention components were expected to cause changes, and plans for testing whether those mechanisms were effective
		(c) Identifies the study design (for example, observational, quasi-experimental, experimental) chosen for measuring impact of the intervention on primary and secondary outcomes, if applicable
		(d) Explains plans for implementing essential aspects of the chosen study design, as described in publication guidelines for specific designs, if applicable (see, for example, www.equator-network.org)
		(e) Describes aspects of the study design that specifically concerned internal validity (integrity of the data) and external validity (generalisability)
11	Methods of evaluation	(a) Describes instruments and procedures (qualitative, quantitative or mixed) used to assess (a) the effectiveness of implementation, (b) the contributions of intervention components and context factors to effectiveness of the intervention and (c) primary and secondary outcomes
		(b) Reports efforts to validate and test reliability of assessment instruments
		(c) Explains methods used to assure data quality and adequacy (for example, blinding; repeating measurements and data extraction; training in data collection; collection of sufficient baseline measurements)
12	Analysis	(a) Provides details of qualitative and quantitative (statistical) methods used to draw inferences from the data
		(b) Aligns unit of analysis with level at which the intervention was implemented, if applicable
		(c) Specifies degree of variability expected in implementation, change expected in primary outcome (effect size) and ability of study design (including size) to detect such effects
		(d) Describes analytical methods used to demonstrate effects of time as a variable (for example, statistical process control)
	Results	What did you find?
13	Outcomes	(a) Nature of setting and improvement intervention
		(i) Characterises relevant elements of setting or settings (for example, geography, physical resources, organisational culture, history of change efforts) and structures and patterns of care (for example, staffing, leadership) that provided context for the intervention
		(ii) Explains the actual course of the intervention (for example, sequence of steps, events or phases; type and number of participants at key points), preferably using a time-line diagram or flow chart
		(iii) Documents degree of success in implementing intervention components
		(iv) Describes how and why the initial plan evolved, and the most important lessons learned from that evolution, particularly the effects of internal feedback from tests of change (reflexiveness)
		(b) Changes in processes of care and patient outcomes associated with the intervention
		(i) Presents data on changes observed in the care delivery process
		(ii) Presents data on changes observed in measures of patient outcome (for example, morbidity, mortality, function, patient/staff satisfaction, service utilisation, cost, care disparities)
		(iii) Considers benefits, harms, unexpected results, problems, failures
		(iv) Presents evidence regarding the strength of association between observed changes/improvements and intervention components/context factors
		(v) Includes summary of missing data for intervention and outcomes
	Discussion	What do the findings mean?
14	Summary	(a) Summarises the most important successes and difficulties in implementing intervention components, and main changes observed in care delivery and clinical outcomes
		(b) Highlights the study's particular strengths
15	Relation to other evidence	Compares and contrasts study results with relevant findings of others, drawing on broad review of the literature; use of a summary table may be helpful in building on existing evidence
16	Limitations	(a) Considers possible sources of confounding, bias or imprecision in design, measurement, and analysis that might have affected study outcomes (internal validity)
		(c) Addresses likelihood that observed gains may weaken over time, and describes plans, if any, for monitoring and maintaining improvement; explicitly states if such planning was not done
		(d) Reviews efforts made to minimise and adjust for study limitations
		(e) Assesses the effect of study limitations on interpretation and application of results
17	Interpretation	(a) Explores possible reasons for differences between observed and expected outcomes
		(b) Draws inferences consistent with the strength of the data about causal mechanisms and size of observed changes, paying particular attention to components of the intervention and context factors that helped determine the intervention's effectiveness (or lack thereof) and types of settings in which this intervention is most likely to be effective
		(c) Suggests steps that might be modified to improve future performance
18	Conclusions	(a) Considers overall practical usefulness of the intervention
		(b) Suggests implications of this report for further studies of improvement interventions
	Other information	Were there other factors relevant to the conduct and interpretation of the study?
19	Funding	Describes funding sources, if any, and role of funding organisation in design, implementation, interpretation and publication of study

*These guidelines provide a framework for reporting formal, planned studies designed to assess the nature and effectiveness of interventions to improve the quality and safety of care. It may not always be appropriate or even possible to include information about every numbered guideline item in reports of original studies, but authors should at least consider every item in writing their reports. Although each major section (that is, Introduction, Methods, Results and Discussion) of a published original study generally contains some information about the numbered items within that section, information about items from one section (for example, the Introduction) is also often needed in other sections (for example, the Discussion).

This table has been taken from the article Publication guidelines for quality improvement in health care: evolution of the SQUIRE project 2008;17:Suppl 1

Supplements

The BMJ Publishing Group journals are willing to consider publishing supplements to regular issues. Supplement proposals may be made at the request of:

1. The journal editor, an editorial board member or a learned society may wish to organise a meeting, sponsorship may be sought and the proceedings published as a supplement.
2. The journal editor, editorial board member or learned society may wish to commission a supplement on a particular theme or topic. Again, sponsorship may be sought.
3. The BMJPG itself may have proposals for supplements where sponsorship may be necessary.
4. A sponsoring organisation, often a pharmaceutical company or a charitable foundation, that wishes to arrange a meeting, the proceedings of which will be published as a supplement.

In all cases, it is vital that the journal's integrity, independence and academic reputation is not compromised in any way.

When contacting us regarding a potential supplement, please include as much of the information below as possible.

• Journal in which you would like the supplement published
• Title of supplement and/or meeting on which it is based
• Date of meeting on which it is based
• Proposed table of contents with provisional article titles and proposed authors
• An indication of whether authors have agreed to participate
• Sponsor information including any relevant deadlines
• An indication of the expected length of each paper Guest Editor proposals if appropriate

For further information on criteria that must be fulfilled, download the supplements guidelines (PDF).