Author: Lynne S. Nemeth

Reporting the Project

After completion of writing and defending a dissertation, I went into a hibernation mode for a period to recuperate from the dual obligations of a full time position within hospital/nursing administration and a full time doctoral student. I submitted abstracts for presentation within nursing research and primary care research meetings and reported my final results in poster and podium presentations. I wanted a break from the writing, and it took me almost a year from my graduation to the completion of a manuscript to briefly describe the results of my research. A new journal was launched during 2005, (the year I completed my dissertation) and it appeared to be a perfect fit for my work. I set my goal for publishing within this open access journal: http://www.implementationscience.com/home/. This journal required suggesting peer reviewers for your topic, which was a new concept for me. Open access was exciting, as the author retains copyright on the material. With complete electronic access, the knowledge developed within one's work has an opportunity to be broadly shared.

I had submitted my manuscript in early June, 2006 and in late July I received the first reviews of the paper. A major revision would be needed, but there were areas where the two reviewers substantially differed. This left me baffled and a bit paralyzed about where to start. It took me nine months before I had another draft. After the second version was completed, both reviewers still raised concerns about changes that were needed. Another six months passed before I overcame the inertia to complete the revision. Eighteen months after I began the process to publish my research within this journal, it was finally accepted: http://www.implementationscience.com/content/3/1/3.

Implementation Science provided a good home for this work. I was encouraged to pursue this venue for publication when the first calls for papers came out, and the the journal's purpose seemed to be so closely aligned to the field of health services research that I was engaged in. Another collaborator that I worked with also pursued publishing a paper in this journal, and his paper was accepted and published quickly. This may have helped me in having co-authored a paper in the journal before my paper was accepted. His paper and my paper were both designated a "highly accessed paper" receiving a large number of downloads within the first month of publication. My paper remains on the list of the highly accessed articles for the past year. In the end, I was significantly humbled by the experience of publishing in this venue as I highly regarded the work being generated in this very high quality journal (the unofficial impact factor for 2008 was 4.43).

The manuscript was late to the field, partly because of my inertia between reviews, and also because I did the initial research early within my doctoral trajectory. As a result, I had to hold off publishing results until my dissertation was approved. The body of knowledge expanded during this time, so that the question about whether or not my work was "new" was being raised within the publication process. There was not another project such as mine reported in the literature on implementing change in primary care practices, and there were not visual models of the process of leading change using electronic medical records. Additionally, I chose to report the research in a format that allowed the voices of the participants to be heard, to provide strength to the argument that a framework for change in primary care practice was needed. By elaborating the meanings of the key themes through the words of the participants, I intended to create a credible and practical framework that could be used by others within the field of primary care improvement.

The conceptual model http://www.implementationscience.com/content/3/1/3/figure/F1 was adopted as one of the three components of the PPRNet-TRIP QI model which includes an intervention model, an improvement model and a practice development model. PPRNet research has evolved since this time, and we now have a significant portfolio of funded research which is underway within primary care practices throughout the United States in 140 practices within 38 states.

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