Whenever I talk to individuals about the process of writing peer-reviewed paper, inevitably the time required to write, revise, and format a paper is a major concern. Ironically, most agree that writing a paper typically takes longer than it should, but almost everyone seems to be resigned to the fact that this can never change. Let’s take a closer look and see if that’s true…

Delays at Start-up

To me, there are really two types of delays: the first occurs at start-up, when there is an idea for a paper and maybe even an initial outline, but the author(s) just can’t seem to get it off the ground, and it ends up wallowing and dying a slow death. (The second type is once there’s a full draft and it needs only author revisions and formatting, which I’ll touch on in the next section.) Delays at start-up are almost always a result of one thing: the author(s) trying to do too much in one paper.

It’s a natural tendency: the full experience of planning, developing, conducting, analyzing, and interpreting the project or intervention probably took months or even years to complete, and there were several significant events that occurred along the way that significantly impacted how it was conducted or what it found. However, trying to compress months or years of activity into one paper is a disaster waiting to happen, because it produces a messy, confusing, complicated paper that is hard to understand or follow. Instead, pick one audience and one message and try to write the shortest paper possible. And then read through it and ask yourself whether everything that is included is truly necessary to provide context or support the results. If it is not, cut it. I promise you that the best papers you will read and the ones you will remember are those with Results sections of only a couple of paragraphs. My ultimate goal one day is to write a paper where the Results section consists of exactly one sentence. Something like, “Results demonstrated a significant improvement in [insert quality measure here] across all major patient characteristics (Figure 1).” Without knowing anything else about that paper, you would probably guess that it has a clear objective and a very specific motivation and intention.

Delays Further on in the Process

The other type of delay occurs once the paper is in full-text draft form with completed tables and figures. In my experience, there are two main causes of these delays: the need for more data analysis (either it wasn’t finished to begin with or there was need for additional analysis), and unresponsive or inefficient co-authors. Since the former scenario is often out of the author’s control, let’s focus on the latter. This type of delay may come in many forms, including:

1. Too many authors. The criteria for who warrants authorship are clear but leave some room for interpretation. Frankly, sometimes the author line is a little bloated with individuals who were only tangentially involved and therefore will have little interest in providing timely feedback. Seriously consider whether individuals listed as authors merit authorship or whether it would be more appropriate for them to appear in the acknowledgement section.

2. Unresponsive authors. Everyone is busy, but there are times when individual authors cannot be bothered to provide comments for several weeks or even months. Expectations should be set up front for all authors, regarding the time and effort they should expect to spend. If they feel they will be unable to adhere to those expectations, they should understand that they may be removed from the authorship line or at a minimum their (late) feedback may not be incorporated.

3. Simultaneous author review. Usually, once the primary author has completed a full draft, he or she will compose an email addressed all of the authors at once, attach the draft, and ask for feedback. Then comes the waiting. Some will return with comments within the hour, others will take weeks or months. Then, once the primary author has received “tracked changes” versions back from everyone (potentially 6 to 8, or even 10 different documents), he or she is charged with incorporating all of the feedback and reconciling any conflicting comments or edits. This process takes forever, and then is repeated multiple times as drafts are iteratively updated. A better process is a sequential review, where each author (in the order in which they appear in the author line) is given the opportunity to review the paper over a specified number of days to include their edits and comments, at which point they send their edited version to the next in line. If done correctly, this can save an immense amount of time (trust me, it works). Further, the version the primary author gets back has been viewed by all and doesn’t require incorporating feedback from multiple versions. During a subsequent (sequential) review those authors who were first in line will be able to see the revisions made by the others; this process can stop once additional changes become rare.

There’s one final aspect to consider for improving the process of author reviews. A colleague of mine tells his co-authors something to the effect of, “Behave like a movie director, not a movie critic.” This means that instead of inserting a comment balloon with some vague concerns (e.g., “This is a confusing way to express this, perhaps this should be re-worded”), the co-author should take the time to edit the text themselves, and to re-word it or change it however they see fit. If they don’t feel comfortable making that level of contribution then one could argue they don’t deserve to be a co-author.

Some of the suggestions in this article may seem a bit harsh, whether it’s ruthlessly cutting out unnecessary details from your paper or demanding co-authors respond in a certain way and within a certain time-frame. I would argue that these are simply attributes of someone who takes paper development seriously and believes strongly in their importance to disseminate information and further the science of healthcare delivery and policy. If you agree, you may want to consider incorporating some of these tactics for your next paper.