Editorial

FigureThe concept of peer review can be interpreted very differently among nurses and healthcare professionals. Some think of a subject expert reviewing a manuscript for a journal's editorial staff. Others think of regulatory bodies requiring hospitals to have an internal process to ensure that healthcare team members are competent and able to perform within their scope of practice.1 Still others think of peer review as a quality assurance process in which healthcare team members audit each other's documentation to validate care standardization. We provide insight into a nursing peer review process designed to evaluate performance, and the journey to its implementation. A well-defined peer review process and tool, utilized in conjunction with a nurse's annual performance evaluation, is one way to infuse meaningful peer input into a performance appraisal. This system allows nurses to provide insight into one another's strengths and opportunities for growth. A detailed approach was used to create, develop, and sustain a nursing peer review program that's flexible enough to be used by all staff members within a pediatric hospital system. In addition to promoting professional growth among nursing staff, this process also meets the current peer review standards set by the Magnet Recognition Program® and The Joint Commission. The ultimate goal of sharing this information is to help other organizations that are just beginning the peer review process and those that have struggled in the past with development and implementation to bring about a sustainable change. This, in turn, will promote nursing cohesiveness and professionalism as we work together to bring healthcare into a new era. Organizational standardization Our organization embarked on an initiative to create a standardized peer review process that would be utilized by all nursing departments. The process needed to be integrated organizationally and applicable to clinical nurses within both inpatient and outpatient environments. This journey began with a review of the current literature and an examination of the current peer review practice at other Magnet® facilities. Through this process, it was discovered that the majority of these facilities utilized and defined peer review in a variety of ways. We identified variation in the management of the peer review process within our own organization. Acknowledging the vast array of discrepancies within and external to the organization, a task force of clinical nurses was developed to redefine the way our organization administered the clinical nurse peer review process. This task force also included two leadership liaisons who served as resources to the clinical nurses during this development and provided insight into the management side of the peer review process. There were four steps in our process: (1) defining a peer, (2) developing a peer review form, (3) transforming the process, and (4) implementing the process. Who's a peer? The first step in our work involved evaluating, discussing, and reaching a consensus on the definition of peer. In order to standardize the peer review process, the task force recognized a true definition was needed to measure success with the new process. Looking at previous peer review practice in the organization, many nurses and department directors had different definitions and ideas of what it meant to be a peer. Some departments included other disciplines in a nurse's specialty for evaluations, whereas others utilized only fellow nursing staff members. The task force agreed that the purpose of peer review is to foster professional growth and development among staff members by utilizing a process through which measurable outcomes are assessed. After much dialog, the task force adopted the definition of peer utilized by the American Nurses Association, which defines a peer as an individual of the same rank or standing according to the established standards of practice.2 Form development The next step in redefining the peer review process was to develop a new peer review tool that could be transferrable and applicable among the various nursing specialties and departments. Key areas identified by the task force for development of this tool included creating a short, concise form that's easy to understand with limited directions and applicable to all clinical nursing departments. To achieve this goal, the task force worked collaboratively to establish eight domains that would provide nurses with a peer evaluation framework. These domains were established through open dialog, including question-and-answer sessions, review of current job descriptions, and evaluation of other tools utilized by various Magnet facilities. Through this work, a common set of core expectations were identified and utilized in the development of each domain. These domains encompass the essential clinical nurse job functions, behavioral competencies, and basic roles and responsibilities throughout the organization. The domains can be found in Table 1.Table 1: The eight domains of peer evaluationTo further guide and support high-quality peer feedback, three to five specific, measurable objectives were created and listed under each domain for nurses to measure performance. These objectives were developed to guide peers in evaluating each nurse by providing focused, pertinent feedback. The task force wanted to eliminate vague, nonspecific feedback that didn't facilitate the identification of future growth opportunities. The objectives created by the task force assist peers in identifying evidence from the nurse's daily work, communication, time management, and interdisciplinary interactions. Each domain also included a comment field, allowing nurses the autonomy to provide open-ended feedback and elaborate on outstanding work or opportunities for the employee's growth and improvement. The comment section was extremely important in the solicitation of meaningful feedback because it allowed nurses to provide examples to reinforce the ratings selected for the objectives. The directions on the new tool clearly state that comments are mandatory for certain ratings to allow for elaboration and examples. The task force believed a Likert rating scale was essential to standardize the peer review process. The previous process utilized a vague, numerical score that hadn't historically provided nurses with adequate descriptions of their work ethic and performance. Lower scores were considered negative responses, whereas higher scores equated to positive responses. After review of the current literature, the task force employed a 4-point Likert scale comprising "not met," "approaching," "meets expectations," and "exceeds expectations." In addition to the scaled questions, an open-ended question "Do you feel comfortable working with this nurse?" was added to the form. Utilizing a mixed-method methodology, Likert scale, and open-ended question format allowed the evaluating nurse a better opportunity to provide real-life contextual examples related to the evaluated nurse's care.3 Process transformation After the peer evaluation tool was created, the task force focused its attention on creating a framework to aid departments in implementing the new peer review process. Throughout our hospital, there are units of vastly different sizes. Some nursing departments have four to six clinical nurses, whereas other departments have as many as 150 to 200 clinical nurses on staff. The variability in staff sizes meant that the task force had to be creative in determining how many peer reviewers should evaluate each nurse annually and how these reviewers should be selected. With the new process, each nurse receives feedback from two to four RNs. Limiting the number of peer evaluations eliminated the previous dissatisfaction and/or barrier of evaluators being asked to fill out 20 to 30 peer evaluations a month due to exceedingly large nursing departments. The task force also allowed clinical nurses to select one to two peers of their choice to provide feedback; the management team selected the remaining peers. Implementation After the task force completed the new peer review tool and process recommendations, the nursing department directors and the CNO gave the approval for implementation. The standardized peer review form, along with the revised process, was implemented using various educational modalities. The first presentation was provided to the inpatient and outpatient nursing directors to inform them about the new form and the revised process. The directors were provided with handouts outlining the changes and educational fact sheets for the staff members to use as a reference. The task force increased its availability to ensure educational consistency to all clinical nurses by attending and presenting at unit-based councils, charge nurse meetings, and department-wide staff development programs. The feedback received from the different educational presentations was extremely positive. Feedback discussed the tool's ease of use, applicability to all nursing departments, appropriate form length, and measurable objectives that allowed nurses to comment on focused job roles and responsibilities. Other feedback included the improved functionality of the new rating scale and the process change that limited the number of requests for peer evaluations. Some directors expressed resistance to changing their current peer review practice. Certain directors thought feedback from four nurses wasn't enough if the department had a high number of nursing staff members. After an open discussion with the task force chairperson and the directors of large departments, it was agreed that meaningful feedback from four people would be adequate. Other directors mentioned that they liked the idea of adding specific clinical skills for peer evaluation. However, we couldn't add specific skills because they wouldn't universally apply to the various nursing department specialties. The task force collected all comments and feedback, and created a frequently asked questions document to address these concerns and explain the thought process behind the decisions made about the tool and recommendations. Directors were then provided with answers to and rationales for their specific questions and concerns, creating a consistent message and clarity to all departments. All education and implementation occurred over the course of 4 months. During this time, the task force worked with web development to formulate an electronic version of the peer evaluation document for the purpose of online submission. The electronic document was widely popular because it eliminated the use of paper and facilitated tool access for all clinical nurses. Staff members were able to complete the tool online and submit the evaluation through the organization's intranet directly to the person who requested the feedback. The task force also concluded that in order for this new tool and process to remain functional and meaningful, continued evaluation of its use would be essential. Reaching the top As we diligently work to move the nursing profession forward, it's important to remember that peer review can positively impact not only an individual's nursing practice, but also an entire hospital system. Nurses are at the forefront of healthcare transformation and are integral to sustainable practice improvement. By empowering clinical nurses to lead this initiative, we've been able to successfully introduce, develop, and support a valuable peer review process across our organization. Utilizing a comprehensive peer review tool can help organizations improve patient outcomes and patient satisfaction.

The received wisdom is that peer review is a thankless task. Peer reviewers are overworked, unpaid, unacknowledged and generally unrewarded. Peer-review processes are not standardized, and each journal or grant review body has its way of deciding what should be approved for publication or funding, respectively. Peer review has also been a secretive process that was largely unstudied until the 1990s. The evidence on peer review in journals has improved in that time, although the central conclusion still holds: peer review is best for improving the quality of articles that editors decide to publish but it is not an objective decision-making process for selecting the best articles. A publication in a major journal is no guarantee of quality and will probably contain several errors, since peer review is poor at eradicating those errors or detecting research misconduct. Sensible journal editors have accepted this reality, and acknowledge the flaws in the system they supervise. Beyond this honest appraisal of peer review, journals can help by introducing open peer-reviewer processes whereby the identity of authors and peer reviewers are not hidden to each other. The research evidence suggests that open peer review does not affect the quality of decision-making at a journal but improves the quality of the conversation between the authors, reviewers and journals. The JRSM has an open peer-review process. The identity of peer reviewers, however, is still usually hidden from readers. Sometimes authors are kind enough to thank peer reviewers in their acknowledgements at the end of a paper. Some journals list peer reviewers without linking them to specific papers – a policy that the JRSM used to follow. A few other journals pay reviewers a small amount or offer them institutional or membership discounts, an existing JRSM benefit. Nonetheless, the reward that peer reviewers receive is paltry in relation to their effort and the contribution that a good peer reviewer can make to improve a paper. Many peer reviewers justify the effort as a necessary contribution to scientific discourse but also as a contribution to their personal development. Many are simply interested enough in the topic to lend their services. Scientific journals only thrive because of the passion of peer reviewers and the patience of readers. From 2010, the JRSM will be taking a bold step in improving the transparency of peer review. We will name peer reviewers on each peer-reviewed article that we publish. This journal does not have the resources to conduct a randomized trial before making this change as bigger journals are able to do. But the editorial team believes that it is the right decision in terms of openness. Any peer reviewers who do not wish to be named can simply decline to peer review the article they have been sent. We would welcome your views on this small but important development.

Peer Review: The Best of the Blemished?

Peer Review in Transplantation.

Scientific journals have been called the ‘minutes of science’ [1]. Born out of the exchange of letters on scientific topics and results, publication is a way of documenting what was done and, particularly in the case of open-access journals, sharing the outcome. Journal publications are considered authoritative and are generally used to inform the work of others, be it further research or, in the case of biomedicine, in treatment decisions for patients. This makes some kind of quality control all the more important. The ‘gold standard’ for this quality control is peer review. Described as a form of self-regulation by qualified members of a profession, it was first introduced by Henry Oldenburg, the founding editor of Philosophical Transactions of the Royal Society, in 1665 as a means of vetting contributions to the Royal Society of London and has persisted in various forms ever since [2]. Peer review is the evaluation of a piece of work by two or more people of similar competence to the authors; but, assuming the reviewing process excludes all those involved in the direct research itself, the persons most qualified to judge the validity of a submitted research paper are precisely those who are the scientist’s closest competitors. This means that the review process can become adversarial, with referees seeming to see it as their responsibility to insist on time-consuming additions and revisions [3,4]. Moreover, under traditional, closed peer-review policies, the identity of the reviewer is withheld from the author, presenting them with a greater opportunity to act arbitrarily. It was in an effort to combat this bias that some journals introduced double-blind peer-review, whereby the author’s name was also concealed from the referee. However, research is a small world and maintaining that blinding often proved impossible. So how did peer review, with these intrinsic issues and biases, become the judicial system of the intellectual world? Simply put, peer review is to science what democracy was to Churchill – ‘the worst form of government, except all those other forms that have been tried from time to time.’ It has served science well, with a widely-held view that, while it may not be perfect, it is nonetheless far better than anything else we have been able to devise. Indeed, the fundamental idea of peer-review seems sound; the issues lie more with the execution. Under closed systems, such as that currently enforced by the Journal of Negative Results in BioMedicine, there is a lack of transparency of the peer-review process and a lack of availability of evaluative information about published articles to the public. Therefore, as of February 2014, the Journal of Negative Results in BioMedicine will adopt an open peer-review policy. Articles already published, or those manuscripts currently submitted, will not be affected by this change. However, for all manuscripts submitted during or after February 2014, authors will see the reviewers’ names and, if the article is published, the reading public will also see who reviewed the article and how the authors responded. This will be available as part of the pre-publication history of the published article. The peer review process will therefore be completely open and transparent, with the peer reviews being part of the record. Research into the effect of open peer review suggests numerous benefits, in particular accountability, fairness and crediting reviewers for their efforts [5-7]. Furthermore, in a recent study, Kowalczuk et al. revealed that reviewer reports operating under an open peer-review system were of overall higher quality than those under a closed system, with higher scores on questions relating to feedback on the methods (11% higher), constructiveness of the comments (5% higher), and the amount of evidence provided to substantiate the comments (9% higher) [8]. Despite this, we recognise that there are also negatives. Some (junior) reviewers may feel uncomfortable signing a critical report, especially when recommending rejection [9]. This reluctance also means that more potential referees may need to be invited to review a manuscript openly than under a closed peer-review system (Parkin EC et al. unpublished observations) [9-11]. Reviewing an article is no easy task and many of us will have faced the situation where it feels we have put more thought into our review of the article than the authors did in designing the study and writing the manuscript. The move towards an open peer-review policy will give credit where it is due, but moreover will provide valuable information to those reading the article, sharing the referees’ critique of the manuscript and presenting all the necessary information for them to make an objective evaluation for themselves.

Background Publishing in scientific journals is one of the most important ways in which scientists disseminate research to their peers and to the wider public. Pre-publication peer review underpins this process, but peer review is subject to various criticisms and is under pressure from growth in the number of scientific publications. Methods Here we examine an element of the editorial process at eLife, in which the Reviewing Editor usually serves as one of the referees, to see what effect this has on decision times, decision type, and the number of citations. We analysed a dataset of 8,905 research submissions to eLife since June 2012, of which 2,747 were sent for peer review. This subset of 2747 papers was then analysed in detail. Results The Reviewing Editor serving as one of the peer reviewers results in faster decision times on average, with the time to final decision ten days faster for accepted submissions (n=1,405) and five days faster for papers that were rejected after peer review (n=1,099). Moreover, editors acting as reviewers had no effect on whether submissions were accepted or rejected, and a very small (but significant) effect on citation rates. Conclusions An important aspect of eLife's peer-review process is shown to be effective, given that decision times are faster when the Reviewing Editor serves as a reviewer. Other journals hoping to improve decision times could consider adopting a similar approach.

Peer review under the spotlight in the UK

The Unique Role of Peer Review Journals

Peer-reviewed journals are a vital source of information exchange for researchers and clinicians in the medical and environmental health arena. The timely publication of credible research is integral to advancing the realm of knowledge in any given topic area. Many Northern Hemisphere journals have access to a range of resources to aid in timely publication: a database of potential peer reviewers, adequate staff and tools to produce each issue, and the funds to ensure publication. However, journals in developing regions such as sub-Saharan Africa usually don’t have these same resources. As a result, publication can be erratic, and important information may not reach the people who need it most. Now a multinational partnership of editors from science and medical journals, including EHP, is working to help African journals gain a greater voice on the scientific publishing stage.

Report from the Working Group of the Molecular Biology Society of Japan for the investigation of fraud in research papers

Editorial Policy

Watch the VIDEO here.Peer review has been a cornerstone of science since the first scientific journals started in the middle of 17th century. It has since evolved from a case by case and non standardized process to a more regulated and organized undertaking. The period at which peer review entered its new phase is the Second World War and the extraordinary boom of scientific output that resulted from the cold war. All this output had to have a receptacle (scientific journals) but also had to be selected due to the big amount of data produced. That is when peer review became unanimously and, to some extent, uniformly implemented. It also became the unavoidable door leading to a number of advantages all researchers are looking for (promotions, funding, prize, etc.).That’s when the human component intervened and made the process a rather biased process subject to all kinds of critics. One of the main (if not the main) problem is the secrecy in which the process is undertaken and that has led to all kind of iniquitous, unjust and sometimes bizarre decisions. The process tried to inject some kind of openness (going from blind to double blind peer reviewing for example) with little results. The 90’s of the last century saw the Internet slowly becoming more and more used in everyday life and, more importantly, in the scientific and academic research. With all the problems besetting peer review ,Internet’s openness seemed as the best cure to all the grievance peer review elicited. Among the most revolutionary experiences, Faculty of 1000 (F 1000), Atmospheric Chemistry and Physics (A.C.P.), Journal of Medical Internet Research (J.M.I.R.), British Medical Journal? Electronic Transactions on Artificial Intelligence ( ETAI) and Biology Direct have introduced new ways to undertake peer review that have somehow alleviated the numerous critics. With Research Ideas Outcomes (RIO), the process enters a new era of openness as its two stages are completely open: the pre submission peer review (part 1) in which the submitter is reviewed before submission by a colleague and could even ask colleagues to help write his proposal and then open post-publication peer-review (part 2) in which the process is even more open as authors could decide what reviews are published, when and also decide to ask for an in house classic type of review done exclusively by peer reviewers from RIO or let the whole community implement a Post Publication Peer Review that could putatively last as long as the article is on the system. All the process is open in all its steps and allows novelty, among others, to recognize namely reviewers’ work, a task they have so far anonymously and without any reward of any kind. This proposal will explain in details the process and try to understand the (r)evolution this kind of process introduces to the making of science through transparency in a stage of science that has been known to be utterly secretive.

Fulfilling the requirements of the Government Performance and Results Act of 1993 has presented Federal science agencies with the challenge of defining ways to quantify and evaluate the outcomes of research. Measuring research program performance is particularly important for the Department of Energy because of its substantial investment (approximately $7 billion in Fiscal Year 1996) in research and development activities. The Research Roundtable, in 1995, observed that the results of research could be evaluated using the performance indicators of relevance, productivity, and quality. One method for doing so is formal, objective evaluation by independent reviewers, or peer review. The objective of the audit was to determine whether the Department had established and was managing a peer review process for evaluating scientific and technical projects. It was found that peer reviews were conducted prior to competitive award of subcontracts, selection of projects from research proposals, and inclusion in scientific journals and/or conferences. In addition, the Department and the laboratories, in response to the government Performance and Results Act and performance-based contracting, had incorporated peer review into the laboratories` annual performance self-assessment process. The results of these reviews were used to determine program direction, obtain input on ongoing programs, and prioritize funding for laboratory and Departmental research activities. This report does not include any recommendations since the laboratories had established processes in accordance with Office of Management and Budget and Departmental peer review requirements.

BackgroundThe Patient-Centered Outcomes Research Institute (PCORI) is obligated to peer review and to post publicly “Final Research Reports” of all funded projects. PCORI peer review emphasizes adherence to PCORI’s Methodology Standards and principles of ethical scientific communication. During the peer review process, reviewers and editors seek to ensure that results are presented objectively and interpreted appropriately, e.g., free of spin.MethodsTwo independent raters assessed PCORI peer review feedback sent to authors. We calculated the proportion of reports in which spin was identified during peer review, and the types of spin identified. We included reports submitted by April 2018 with at least one associated journal article. The same raters then assessed whether authors addressed reviewers’ comments about spin. The raters also assessed whether spin identified during PCORI peer review was present in related journal articles.ResultsWe included 64 PCORI-funded projects. Peer reviewers or editors identified spin in 55/64 (86%) submitted research reports. Types of spin included reporting bias (46/55; 84%), inappropriate interpretation (40/55; 73%), inappropriate extrapolation of results (15/55; 27%), and inappropriate attribution of causality (5/55; 9%). Authors addressed comments about spin related to 47/55 (85%) of the reports.Of 110 associated journal articles, PCORI comments about spin were potentially applicable to 44/110 (40%) articles, of which 27/44 (61%) contained the same spin that was identified in the PCORI research report. The proportion of articles with spin was similar for articles accepted before and after PCORI peer review (63% vs 58%).DiscussionJust as spin is common in journal articles and press releases, we found that most reports submitted to PCORI included spin. While most spin was mitigated during the funder’s peer review process, we found no evidence that review of PCORI reports influenced spin in journal articles. Funders could explore interventions aimed at reducing spin in published articles of studies they support.

Networks of Editors: Useful for Researchers