Commissioning Editor Introductory Blog: Living up to more diversity and inclusion in health care leadership (research) by Jamiu O. Busari

Introduction

BMJ Leader (BMJL) is one of the BMJ’s journals and is co-owned by BMJ and the Faculty of Medical Leadership and Management. It is an international, peer-reviewed, online-only journal that focuses on healthcare management and leadership. BMJL is constantly expanding its scope and taking bold steps to be a more inclusive search journal. We are recruiting more contributions from underrepresented groups and communities. There is also a renewed focus on diversifying the journal’s pool of editors, reviewers, and contributors. With these efforts and more, BMJL aims to be an academic outlet that resonates with and is accessible to a global healthcare (leadership) community.

So why is a renewed focus on diversity and inclusion (DI) in research important to BMJL? Let us first examine some facts about DI in scientific research. In 2021, the National Science Board reported that countries with high-and upper-middle-income economies accounted for 90% of the 2.9 million scientific articles published globally. Six countries China, the united states, India, Germany, the united kingdom, and Japan together, accounted for 54% of this number, with China ranking number one on the list. Over the past two decades, high-income economies like the United States, the United Kingdom, Germany, France, and Japan have steadily increased their large base of scientific publications.

Meanwhile, lower-middle-income and upper-middle-income economies such as India, China, Iran, Russia, and Brazil have rapidly increased their outputs, starting from a lower base of scientific publications in 1996. Data on article citations have also shown that the United States, United Kingdom, Netherlands, and Switzerland, are some countries with reported high-impact research papers. As academics and scientific researchers, we constantly seek to improve, explore, develop and disseminate (new) knowledge within our communities. In the field of medicine, these aspirations are reflected in the way we design our health services, develop medical curricula (Canmeds, UK)  and implement our management and leadership systems. Central to these focus areas is the need for continuous, credible, and robust scientific research to help guide equitable healthcare decision-making. So, besides upholding the morals and ethics of scientific research, an essential prerequisite for equitable decision-making is ensuring sufficient diversity and representation in the way scientific research is conducted and disseminated

The ethos  of scientific research

In 1942, sociologist Dr. Robert Merton proposed the ethos that should be applied to science, later called the Mertonian norms. In his writing “A Note on Science and Technology in a Democratic Order,”  Merton argued that while no formal scientific code exists, the values and norms of modern science can be inferred from standard codes of scientific practice and widely held attitudes.  To explain this, he described four idealized norms, namely: Universalism – The idea that scientific claims must be held to objective and “preestablished impersonal criteria, Communality or Communalism – the findings of science are common property to the scientific community, and that scientific progress depends on open communication and sharing, Disinterestedness – Science should limit the influence of bias as much as possible and should be done for the sake of science, rather than self-interest or power, and Organized Skepticism– the necessity for proof or verification of our discoveries, which subjects science to more scrutiny than any other field. This last norm emphasizes the need for peer review and the value of reproducibility.

Limiting bias and promoting inclusion in scientific research

Of the four norms of the scientific ethos, upholding disinterestedness (i.e., limiting the influence of bias and doing science for the sake of science) seems to be the most challenging in Academia, research, and scientific publications. Over the years,  bias in science has gradually grown and expanded beyond the performance of research to include practices that systematically disadvantage, exclude, or limit the participation of certain groups of scientists. For example, Hofstra et al., 2020 explored the diversity-innovation paradox in science. The authors investigated why, despite the premise that diversity breeds innovation, underrepresented researchers that diversify organizations are less successful in their careers.  They were also interested in knowing if the diversity paradox holds for scientists. They used a near-complete population of approximately 1.2 million US doctoral recipients (1977 to 2015), following their careers into publishing and faculty positions. Their findings revealed that underrepresented groups produced higher rates of scientific novelty. However, their novel contributions were devalued and discounted.  For example, novel contributions by gender and racial minorities were taken up by peers at lower rates than novel contributions by gender and racial majorities. Equally, impactful contributions of gender and racial minorities did not necessarily result in successful scientific careers compared to majority groups. The findings suggest that there are unwarranted reproductions of stratification in Academia. Unfortunately, these reproductions disregard the underrepresentation of certain groups in Academia. These stratifications also seemed to ignore the diversity in scientific research (innovation).  This fact and more shows that the world of science is (still) unfair, and disparities are persistent among underrepresented groups in both science and publishing due to inequalities within our scientific communities.

BMJ and Equity, Diversity and Inclusion (EDI)

As far back as 2006, affirmative initiatives such as #MeToo and Black lives matter have emerged to tackle inequitable and unjust systems in our societies.  Many of these observed inequities are not limited to health care, entertainment, and corporate industries but also involve (higher) education, scientific research, and publications. With this knowledge, the BMJ  made a public commitment on the 23rd of July 2021 to take proactive steps to promote EDI across its company and journals. In a series of public commitments that followed, the company promised through its journals to stand up for equality, diversity, and inclusion in research, clinical practice, and scholarly communication. Some concrete steps were mapped out to achieve this, which included developing inclusive guide styles for BMJ journals, diversifying editorial boards, encouraging diversity of authors and reviewers, and monitoring the gender and ethnicity distribution in submissions received.

Commissioning editor at BMJ Leader

The overarching aim of BMJL is to improve the outcome and experience of health and care delivery systems for patients, populations, and workforces. To deliver on this purpose,  BMJL focuses on building better leaders who are resilient and equipped with practical leadership skills and knowledge. The journal strives to achieve this by showcasing original research and reviews, interpretations of the evidence base, reflections, and debates by practitioners on key healthcare management and leadership themes. The commissioning editor (CEd) participates in achieving these goals but, in particular, is responsible for commissioning high-quality, topical articles and special issues. In addition, the CEd actively drives the recruitment of contributors and the peer review process of manuscripts submitted to these issues. I have recently taken over the CEd role at  BMJ Leader, succeeding my predecessor Dr. Anthony Berendt. I am grateful to Dr. Berendt for the foundation he laid during his tenure as CEd, which I shall be building on. As the new commissioning editor, my primary goal would be to expand the  Journal’s set objectives – to make it more inclusive and ensure more diversity in content, contributors, and reviewers. Specific activities I intend to undertake  to achieve this include:

  • driving and curating new ideas for the journal
  • Helping to expand the reach of the journal  by  involving and increasing participation from Asia, Africa, and Latin America
  • Facilitating contributions from a (more) diverse profile of authors, e.g., including allied health professionals, residents, and students

I shall also promote new domains of interest and recruit contributions from various authors. These domains include :

  • Equity and (Healthcare) Leadership
  • Climate change and (healthcare) leadership
  • Health care leadership education
  • Kindness and kinship in health care
  • Leadership challenges from X
  • Digital technology and health
  • The intersection between politics and health care – implications for leadership

Conclusion

Moving forward,  the BMJ leader editorial team and the  CEd plan to provide more diversity and representation in the research work we publish and the reviewers we recruit.  Without compromising the journal’s standard, we shall continue to uphold the ethos of scientific research, limiting bias and promoting the inclusion of research from underrepresented countries and groups. We shall also facilitate more opportunities to enable our contributors and readers to be part of our healthcare leadership research community. In conclusion, BMJL is looking to grow and further diversify the profile and focus of its editorial team. Therefore, if you are interested in being part of the journal’s leadership aspirations, be on the lookout for the call for associate editor posts soon to be announced.

References:

Merton, Robert K. 1973. The Sociology of Science: Theoretical and Empirical Investigations. University of Chicago Press.

Dr Jamiu Busari

Jamiu Busari is an associate professor of medical education at Maastricht University and a consultant pediatrician and Dean HOH Academy at Horacio Oduber Hospital, Aruba. He is an Associate Editor at BMJ Leader and recently been appointed as Commissioning Editor for the journal. He is a public speaker, writer, educator, and health care leader. He is also a fervent advocate for diversity, equity and inclusivity towards the marginalized in society.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.

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