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Expectations Exceeded

From: The Hospitalist, November 2011

First editor-in-chief leaves indelible mark on JHM.

by Mark Leiser

A look back at Mark Williams’, MD tenure as JHM’s first editor-in-chief

When HM pioneers identified potential candidates to become editor-in-chief of a new peer-reviewed journal dedicated to their specialty, they found themselves working from a short list. The term “hospitalist” had been part of the American healthcare lexicon for less than a decade, and only a select few in the young field possessed the leadership, management experience, and research credibility to fill the role.

Mark Williams, MD, FACP, FHM, then a professor and director of the hospital medicine unit at Emory University School of Medicine in Atlanta, met the criteria. He also demonstrated two attributes that distinguished him from other finalists. First, he understood the Journal of Hospital Medicine’s mission, having led an SHM task force that created a development plan for the publication. More importantly, he had the personality to sell JHM as a valuable tool for researchers and frontline hospitalists long before the first issue rolled off the press, says Robert Wachter, MD, MHM, professor and associate chairman of the Department of Medicine at the University of California at San Francisco (UCSF), chief of the division of hospital medicine and chief of medical service at UCSF Medical Center, and one of the HM leaders who advocated for the journal’s launch.

“The early phase is particularly tricky in that you are trying to get an entire specialty interested in something that is conceptual,” Dr. Wachter says. “If you can’t, you don’t ever develop the momentum to build the thing you’re talking about. If you can, you get people excited and jazzed about it before it’s real, so when it becomes real, you have accomplished, talented people truly engaged. The latter was the experience with Mark.”

Dr. Williams did more than generate excitement. He assembled a diverse editorial team and developed a comprehensive content plan that, over the next six years, helped JHM evolve into a frequently cited, well-respected publication.

“It has exceeded my expectations,” Dr. Wachter says, “and my expectations were pretty high.”

SHM president Jeff Wiese, right, presents outgoing JHM editor-in-chief Mark Williams a commemorative plaque at HM11 in Dallas.

Getting Off the Ground

By the turn of the century, HM achieved many of the milestones its leaders believed were necessary to solidify itself as a specialty—it had formed a society, published textbooks, and held regular conferences. The next step, they believed, was the launch of a peer-reviewed journal.

Discussions continued for a few years until proponents believed a sizable readership base existed, and that HM had enough established researchers and authors to sustain a journal. In March 2005, SHM appointed Dr. Williams, who had reviewed and written journal articles but never served as an editor, as JHM ’s editor-in-chief and scheduled a February 2006 launch.

“Off we went, with me not really having any clear idea what I was getting myself into,” says Dr. Williams, a former SHM president who now is a professor and chief of the Division of Hospital Medicine at Northwestern University’s Feinberg School of Medicine in Chicago.

He immediately immersed himself in other top-tier journals he hoped to emulate. He also began formulating strategies to tackle two significant challenges. The first—promoting the publication—meshed perfectly with his persona, says Vineet Arora, MD, FHM, assistant dean for scholarship and discovery at the University of Chicago’s Pritzker School of Medicine.

During HM05 in Chicago, Dr. Williams handed out business cards to annual meeting attendees and encouraged every presenter to submit his or her research to the journal.

“Everyone was so excited to meet him and to find out there was a home for their work,” Dr. Arora recalls. “Mark was really successful, right from the start, at building those bridges and making sure everybody felt part of the team.”

Mark sets the strategic vision and empowers his team to execute. He is always open, and he encourages ideas. He’s a facilitator, which is what a great leader is.

—Brian Harte, MD, SFHM, chief operating officer, Hillcrest Hospital, chairman of hospital medicine, Cleveland Clinic, JHM deputy editor

The second challenge—lining up content for the inaugural issue—proved easier than anticipated. Diane Meier, MD, FACP, an internationally recognized expert on palliative care, and C. Seth Landefeld, MD, FACP, chief of the Division of Geriatrics at UCSF, submitted review articles. Christine Cassel, MD, FACP, president and CEO of the American Board of Internal Medicine, wrote an editorial. Diane Payne, publications director for the Board of Regents for the University System of Georgia, submitted what remains Dr. Williams’ favorite JHM article, a patient commentary titled “Hospitals Foreign Soil for Those Who Don’t Work There.”

The first issue also included The Core Competencies in Hospital Medicine: A Framework for Curriculum Development, a blueprint created by SHM to help medical schools and post-graduate programs develop standardized curricula for teaching HM. The supplement remains the most-cited article in JHM history.

“We were told over and over the biggest problem we’d face would be getting enough content,” Dr. Williams says. “We were flooded with content from day one. That tells me we probably could have started this journal a year or two earlier, but this ensured our success.”

Success from the Start

JHM ’s success continued beyond the inaugural issue. Less than a year after the launch, it was selected for indexing and inclusion in MEDLINE, a U.S. National Library of Medicine bibliographic database that contains more than 18 million references to journal articles in medicine and other life sciences.

In summer 2009, it received a debut 3.163 Impact Factor, an industry metric that calculates average citations received by peer-reviewed journals. The score ranked JHM in the top 20% of its cohort, a stronger-than-expected showing for a journal in its fourth year of publication.

An increasing amount of original research helped JHM become a valuable educational tool, and nearly 10,000 journal articles have been downloaded since its inception, Dr. Williams says.

Listen to Mark Williams, MD, FACP, FHM

The journal’s clinical vignettes and articles that explain how political developments affect HM are especially beneficial, says James Neviackas, MD, a hospitalist at Decatur Memorial Hospital in Illinois. The format also serves hospitalists well.

“The articles are short and hard-hitting, so they enable me to get as much information as I can in as little time as possible,” Dr. Neviackas says.

Dr. Williams deserves credit for making the journal a viable and valuable publication, says Dana P. Edelson, MD, FHM, assistant professor at The University of Chicago’s Department of Medicine and a JHM assistant editor.

“To build it from nothing into a well-regarded academic journal in a matter of few years is pretty amazing,” Dr. Edelson says. “From a success standpoint, it’s truly remarkable.”

I thought I’d get nasty emails saying, “Why are you rejecting my article? Clearly you don’t understand what I’m doing.” Invariably, I get emails along the lines of, “Thank you so much for carefully reviewing the article. I deeply appreciate the insightful comments from the reviewers.” That has been very rewarding.

—Mark Williams, MD, SFHM, professor, chief, division of hospital medicine, Feinberg School of Medicine, Northwestern University, Chicago, former SHM president, JHM editor-in-chief, 2006-2011

Dr. Williams inspires members of his editorial staff “to bring their A game” by giving them considerable authority, valuing their opinions, and demonstrating a willingness to support their decisions, even when they risk angering authors whose articles are rejected, Dr. Edelson says.

“Mark has shown a combination of operational capabilities, organizational skills, and servant leadership that is really inspirational,” adds deputy editor Brian Harte, MD, SFHM, chief operating officer of Hillcrest Hospital in Ohio and chairman of hospital medicine at The Cleveland Clinic. “He sets the strategic vision and empowers his team to execute. He is always open, and he encourages ideas. He’s a facilitator, which is what a great leader is.”

Dr. Williams, in turn, credits the support of JHM ’s publisher, John Wiley & Sons Inc., which also publishes The Hospitalist, and his editorial team for the journal’s achievements. He also praises his team for ensuring his greatest fear—constant complaints from authors whose papers were rejected—never came to fruition.

“I thought I’d get nasty emails saying, ‘Why are you rejecting my article? Clearly you don’t understand what I’m doing,’” Dr. Williams says. “Invariably, I get emails along the lines of, ‘Thank you so much for carefully reviewing the article. I deeply appreciate the insightful comments from the reviewers.’

“That has been very rewarding,” he adds. “It demonstrates we have done a terrific job of candidly and fairly reviewing articles … and that the amount of effort we put into providing those reviews is recognized and welcomed and appreciated.”

The Transition

Dr. Williams will serve as the journal’s editor-in-chief through the end of the year. Andrew Auerbach, MD, MPH, SFHM, associate professor of medicine at UCSF and director of research for the Division of Hospital Medicine, will take over in January.

Dr. Auerbach, who will serve a five-year term, says Dr. Williams has “done a remarkable job” developing HM’s only peer-reviewed journal. “He raised the visibility of the journal inside the field of hospital medicine and outside,” Dr. Auerbach says. “He built a publication that is really aligned with what hospitalists are doing and what they want to do.”

Dr. Williams is helping Dr. Auerbach develop a strategic plan for the first 18 months of his term, but he looks forward to having more time to mentor junior faculty at Northwestern. He’ll leave the editor’s chair with two pieces of unfinished business: The economic downturn thwarted his effort to increase JHM ’s publishing frequency from nine to 12 times a year, a move he hopes is made next year; he also fell short of his goal to feature regular patient commentaries, such as Diane Payne’s editorial in the inaugural issue.

Although he takes pride in the journal’s cover design, which includes three photos that he says convey HM is about caring for people, he hopes patients’ voices are better represented in future issues.

“We’re all about taking care of patients. That’s our purpose,” he says. “Too often, health care providers get busy and they forget that. They don’t realize how difficult it is for patients to go through the struggles of obtaining healthcare and being in a hospital when they are incredibly sick.”

‘A Big Tent’

Despite the challenges associated with starting a journal from scratch, Dr. Williams says his six years at the helm went more smoothly than he could have imagined. The effort has paid off.

JHM’s Impact Factor, although down from its debut figure, rose to 1.951 last year from 1.496 in 2009, ranking it 40th out of 151 journals in its cohort.

The success, Dr. Wachter says, shows Dr. Williams was the right choice to lead JHM from birth through toddlerhood.

More importantly, Dr. Williams embraced the vision of HM leaders who believed the journal needed to be a big tent in order to succeed. “We wanted to try to somehow hit the sweet spot of being relevant and interesting to folks who practice hospital medicine in a wide array of circumstances,” Dr. Wachter says, “while also being a go-to place for researchers to submit their research. That was ambitious, and that could have failed in all sorts of directions. It could have been quite relevant to clinicians, but not rigorous enough for researchers. It could have been perfect for researchers, but the clinicians could have felt it wasn’t relative to their day-to-day life. I think the journal has done a masterful job negotiating that tight wire.”

Mark Leiser is a freelance writer based in New Jersey.

JHM Reflections

“Under Mark’s steady hand ... JHM hit the ground running and never looked back, and his successor, while undoubtedly facing a new set of challenges, inherits an enterprise that is infinitely more stable and certainly more tangible than the one Mark had the vision and courage to take the helm of. I consider it one of the great privileges of my professional life to have had the opportunity to serve with and under Mark since 2005, and he has my eternal respect and gratitude for the job he’s done as EIC.”

—James C. Pile, MD, SFHM, Case Western Reserve University at MetroHealth Medical Center, JHM deputy editor

“JHM’s integrity has been unquestioned; this is a direct reflection upon your character.”

—Jack Percelay, MD, MPH, FAAP, SFHM, E.L.M.O. Pediatrics, SHM board member, JHM associate editor

“For the past five years, Mark has helped open doors, advise me in my own career, and been a phenomenal friend, resource, and role model. It’s been a singular honor to be part of his team. ... Mark has shown a combination of operational capabilities, organizational skills, and servant leadership that is really inspirational. He sets the strategic vision and empowers his team to execute. He is always open, and he encourages ideas. He’s a facilitator, which is what a great leader is.”

—Brian J. Harte, MD, SFHM, Cleveland Clinic, JHM deputy editor

“Mark has this remarkable ability to give controlled and constructive feedback. After a string of very slow (or non-) responses from reviewers of several manuscripts, I decided to “ramp up” the number of reviewers on a manuscript that I thought was pretty decent. Being the week before the Christmas/New Year holidays, I sent the manuscript out to eight reviewers. Mark’s comment: Not a “Hey, dumbo, 8 is absurd” or a “you’re decimating our reviewer pool,” but a calm, calculated, four-word email: “Wow. 8 reviewers. Seriously.”

—Danielle Bowen Scheurer, MD, MSc, SFHM, Medical University of South Carolina, JHM associate editor

“Starting only with a vision, you’ve created an indelible mark on the field of Hospital Medicine, and have inspired others through your uncanny mix of modesty, undying praise for others’ work, enthusiasm, and high standards.

—Daniel Brotman, MD, FACP, FHM, Johns Hopkins Hospital, JHM deputy editor

“Congratulations, Mark. Your tenure as an editor is another tribute to your determination, commitment, enthusiasm, and your commitment to patients and colleagues. The evolving field is indebted to you.”

—Kelley M. Skeff, MD, PhD, MACP, Stanford University School of Medicine, JHM editorial board

“Thanks for all your hard work getting the journal off the ground. It’s been great to see it take off under your leadership, from a fledgling idea to a well-cited resource. Your passion for the organization definitely comes through.”

—Vineet Arora, MD, FHM, University of Chicago School of Medicine, JHM assistant editor


This copy is for your personal, noncommercial use only. No part of this article can be reproduced without the written permission of the publisher. Order presentation-ready copies for distribution to your colleagues, clients, or customers by contacting our reprints department at reprints@wiley.com. Copyright © 2009 Society of Hospital Medicine, administered by John Wiley & Sons Inc.

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The Hospitalist newsmagazine reports on issues and trends in hospital medicine. The Hospitalist reaches more than 25,000 hospitalists, physician assistants, nurse practitioners, residents, and medical administrators interested in the practice and business of hospital medicine.

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