Acknowledgement in Healthcare Improvement Projects: Recognising Contributions Fairly

Why this topic matters

Proper acknowledgement serves multiple important purposes in healthcare improvement:

• Fairness and Professionalism: It ensures individuals are given credit for their work, reinforcing professional standards and ethical conduct.
• Motivation and Engagement: Recognising contributions motivates staff, reinforces their value to the team, and encourages continued engagement in future improvement work.
• Team Cohesion: A culture of fair acknowledgement strengthens team bonds and promotes a positive working environment.
• Transparency and Trust: Clearly stating who contributed what builds transparency, which is vital for trust within the team and with external stakeholders.
• Career Progression: For junior staff and trainees, formal acknowledgement can be crucial for CVs, portfolio development, and future opportunities.
• Organisational Memory: It helps to document the breadth of involvement, which can be useful for understanding project history and sustainability.

Failing to acknowledge contributions can lead to resentment, de-motivation, and negatively impact future willingness to participate in improvement initiatives.

Practical explanation: Who and how to acknowledge

Acknowledgements typically appear at the end of a report, paper, or presentation, before the references. They should be clear, concise, and specific. When considering who to acknowledge, think broadly about everyone who provided significant input, support, or resources that are not covered by authorship.

Distinguishing Authorship from Acknowledgement

It's important to differentiate between authorship and acknowledgement. Authorship usually implies significant intellectual contribution to the conception, design, execution, analysis, or interpretation of the work, and approval of the final version. It also entails accountability for the work.

Acknowledgement, on the other hand, is for individuals or groups who contributed to the work but do not meet the criteria for authorship. This distinction is particularly important for research publications, where specific criteria (e.g., ICMJE guidelines) apply for authorship. For QI reports or audits, the lines can sometimes be less rigid, but the principle remains: authorship for primary intellectual and practical heavy lifting, acknowledgement for significant support.

Categories of Contributors to Acknowledge

Consider acknowledging individuals or groups who provided:

1. Technical and Practical Support:
   • Statistical advice (if not an author)
   • IT support for data extraction or system development
   • Administrative assistance (e.g., scheduling meetings, formatting reports)
   • Librarian services for literature searches
   • Dedicated time and effort in data collection or data entry.
2. Clinical Input and Expertise:
   • Specialist clinicians who offered specific advice or review of clinical content (e.g., patient pathways, safety protocols).
   • Ward staff, nurses, radiologists, pharmacists, or physiotherapists who facilitated data collection or provided feedback on proposed changes.
3. Managerial and Organisational Support:
   • Service managers who facilitated operational changes or allocated resources.
   • Clinical directors or governance leads who provided strategic oversight or approval.
   • Audit or QI department staff who offered guidance on methodology or local processes.
4. Funding and Resources:
   • Organisations or departments that provided direct funding, equipment, or protected time for the project.
5. Patient and Public Involvement (PPI):
   • Patients, carers, or public representatives who contributed to the design, execution, or dissemination of the project. This is increasingly vital and should be specifically highlighted.
6. Writing and Editing Assistance:
   • Professional medical writers or editors, if their work does not meet authorship criteria.

How to Phrase Acknowledgements

Acknowledgements can be grouped by category or listed individually. Be specific about the nature of the contribution, if possible, without going into excessive detail.

Examples:

• "The authors would like to thank Ms Sarah Davies for her invaluable assistance with data collation and database management."
• "We are grateful to the Intensive Care Unit nursing staff for their diligent efforts in implementing the new patient handover protocol and providing constructive feedback."
• "Special thanks are extended to the Health Informatics team for their support in extracting anonymised patient data from the electronic health record system."
• "This project received funding support from the local NHS Trust Charity for the development of patient education materials."
• "We acknowledge the input of our Patient and Public Involvement panel for their feedback on the project design and patient information leaflet."

Common pitfalls

• Overlooking Junior Staff: Often, junior doctors, nurses, or administrative staff contribute significantly to data collection or practical implementation. Ensure their efforts are recognised.
• Generic Acknowledgements: Avoid vague statements like "Thanks to everyone involved." Be specific; it shows thought and genuine appreciation.
• Late Consideration: Don't leave acknowledgements until the very last minute. Keep a running log throughout the project of who has helped and how.
• Assuming Authorship: Do not assume someone prefers acknowledgement over authorship, or vice-versa. Have open discussions early in the project about contributions and publication plans.
• Forgetting Ethics/Governance Teams: These teams provide crucial support and guidance, ensuring your project is compliant and ethical. Acknowledge their role.
• Not Including PPI: Missing out on acknowledging patient and public contributors can undermine the spirit of co-production and lead to negative perceptions.

Step-by-step approach to ensuring fair acknowledgement

1. Start Early: At the project's outset, discuss potential contributors and their roles. Consider who might be an author and who might be acknowledged.
2. Keep a Log: Maintain a simple spreadsheet or document detailing individuals, their contributions, and their preferred contact details (if you need to seek permission for acknowledgement).
3. Regular Review: Periodically (e.g., at major milestones or team meetings) review the log and update it. Ask team members, "Has anyone else helped us significantly?"
4. Seek Permission: Before publicly acknowledging an individual by name, always ask for their permission. This is a professional courtesy and confirms they are happy with the description of their contribution.
5. Draft and Share Acknowledgements: When you draft your report or paper, write out the acknowledgements section. Share it with your core project team for review, ensuring no one has been missed and the wording is accurate.
6. Be Specific: Clearly describe the nature of each contribution to provide meaningful recognition.

Example in clinical practice: Implementing a new sepsis screening tool

A multidisciplinary team on a medical ward implements a new digital sepsis screening tool. The project involves a QI lead, two junior doctors, a ward sister, the IT department, and a patient representative group.

Authorship: The QI lead, one junior doctor (primary data analyst and report writer), and the ward sister (lead for nursing implementation) meet authorship criteria.

Acknowledgements would include:

• Other Junior Doctor: For extensive data collection shifts and initial pilot testing of the tool.
• IT Department: For customising the electronic health record system to integrate the new screening tool and providing technical support during rollout.
• Consultant Microbiologist: For reviewing the clinical diagnostic pathway and providing advice on antibiotic stewardship.
• Patient Representative Group: For their valuable input on the user interface and clarity of patient information regarding sepsis.
• Hospital Audit Department: For their guidance on project registration and methodology.
• Ward Manager: For facilitating staff training and releasing staff for project meetings.

The acknowledgement section would specifically mention the input of each group or individual, detailing their particular contribution.

How Lazomis can help

Lazomis supports your improvement projects from inception to dissemination. Our platform offers features that can indirectly assist with this crucial aspect of project management:

• Project Management Tools: Use Lazomis to log team members' roles and contributions from the start, making it easier to track who has helped and in what capacity.
• Document Management: Store versions of your project outlines, meeting minutes, and draft reports within Lazomis, allowing you to easily revisit discussions about roles and responsibilities.
• Collaboration Features: Facilitate discussions within your project team about authorship and acknowledgements, ensuring consensus and transparency.
• Report Generation: As you prepare your final reports, the structure provided by Lazomis can prompt you to include a comprehensive acknowledgement section, ensuring this important step isn't overlooked.

Adopting good practices for acknowledgement is part of a broader commitment to robust project management, which Lazomis is designed to support.

Key takeaways

• Acknowledge all significant contributions to your healthcare improvement projects, even if they don't meet authorship criteria.
• Distinguish clearly between authorship (significant intellectual contribution and accountability) and acknowledgement (significant support).
• Keep a running log of contributors and their specific roles throughout the project lifecycle.
• Always seek permission before publicly acknowledging individuals by name, and be specific about their contribution.
• Fair acknowledgement fosters professionalism, motivates staff, and strengthens team collaboration.

This resource supports, but does not replace, clinical judgement. Local policy, formulary and specialist advice should be followed.