Few newsletters are worth the devastation of rain forest to which they are contributing. They are conceived in haste, often by a general practitioner, consultant, or manager who realise that their new expensive software has a desktop publishing facility. They are executed reluctantly, often by a junior member of staff who has neither the training nor the enthusiasm to be an editor. And they are scoffed at by would be readers as blatant propaganda, or left unread in embarrassing piles, until about the third edition, when the enterprise quietly collapses.
Yet effective newsletters are an important asset. They can distribute information cheaply and effectively. They can improve morale. And they can act as a focus for change, encouraging participation by those at the bottom as well as the top, by patients as well as providers.
So what makes the difference? How can editors overcome their many problems (box). How can they ensure that a newsletter is worth the paper it is printed on?
The worst thing to do is to rush into print. A newsletter is only launched once, and time spent on planning will repay itself once the glow of being a press tycoon has died down.
The most important decision is: who will be the editor? By this I do not mean who wants to be listed as such (leaving others to do the real work), but who will have, and be allowed to exercise, the responsibility of commissioning and approving articles, ensuring regular publication, and taking the blame if things go wrong?
The editor is the hub around whom the publication turns, or grinds to a halt. He or she must motivate and monitor a range of people: writers, editors, photographers, illustrators, typesetters, publishers, and distributors. At the same time he or she will have to balance three often conflicting needs: reliability, resources, and readability.
Any publication set up to serve the needs of an organisation must avoid subverting that organisation, whether knowledge or (more commonly) unknowingly. As editor, you can minimise that risk. Firstly, make sure that your lines of reporting to a group of colleagues (editorial board) or your immediate superior (who then becomes editor in chief) are clear. This should simplify the political task of the editor by avoiding the trap of having too many masters or mistresses to please.
Secondly, agree with the editor in chief on the purpose of the newsletter: draft, discuss, and write down a clear mission statement. Many strains are caused by the editor producing one publication while the editorial board or the editor in chief (and his or her superiors) want another. Clear aims are important: there is a huge difference between a newsletter for staff and one for patients or between one intended to provide information and another to stimulate debate. Agreeing in advance will not only reduce friction but also determine style and content.
Thirdly, decide what refereeing systems you need. Sending copy to interested parties is time consuming, encourages endless debates over the exact usage of a semicolon, and leads to safe, often sycophantic, material. But it does reduce avoidable errors and ensures that unexpected time bombs can be defused before publication. The choice is yours, but if you decide on a refereeing system make sure that your schedules (see below) reflect that.
Editors must ensure that they have enough resources from the start. The obvious costs will be typesetting, printing, paper, distribution, contributions, and illustrations. Less obvious are overheads and staff time, yet these are vital. In particular, make sure that those working on the newsletter are not expected to take on new tasks without being allowed to shed old ones (unless they are underemployed). If this is unrealistic, consider outside help. Do not be put off that this will show the real cost: work out the unit cost (per person per edition). Then decide whether it is worth it or whether you can make do with something cheaper, such as two pages of black and white instead of 12 pages of full colour. Do not forget to take into account the savings that you can make by winding up existing, less efficient, ways of communicating.
Readers are the third element of the editor's infernal triangle. They are often neglected. Many publications fulfil the needs or egos of managers, or explore the minutiae of technical matters, but are left unread or despised by their intended readers. They have failed.
How can editors attract and keep readers? Mainly by keeping them their main priority at all times but also by careful planning, sensible selection of articles, shrewd appointments, effective team leadership, and a wise use of training courses. Cherish your contributors: if you feel they are apathetic ask, "What's in it for them?" Give rewards, such as prominent bylines, parties, meetings (but make sure that these keep to an advisory role). A neglected technique is the simple "thank you," which costs nothing.
You will soon realise that the goal of pleasing your readers conflicts with the goal of playing safe and saving money. For instance, an article exposing the sexual peccadillos of the senior anaesthetists will be avidly read, but your editorship is unlikely to survive long. A drive to cut costs will save funds but could force down the quality so much that readers stop reading. Such conflicts, however, are the essence of editing, and good editors will enjoy the challenge.
Once you have set up an effective structure, work out how you are going to produce your newsletter.
TYPESETTING AND LAYOUT
Typesetting and layout are the processes whereby subedited manuscripts or disks are turned into finished pages, ready for reproduction. The simplest method is to type the copy neatly (fig 1). Wordprocessing packages allow you to edit manuscripts on screen, arranged in order from the top of the page to the bottom. Desktop publishing systems, such as Quark Xpress, Ventura, and Pagemaker at the top of the scale, go one stage further and allow you to import articles from a wordprocessing package, edit them, and then paste up text and graphics in any order on simulated pages on screen. This gives you much more flexibility. A final method is hard copy, in which manuscripts are sent to a professional typesetters, who will provide galley proofs to read and then paste up according to your rough design. This is old technology: it is relatively easy but time consuming, and you will have less control.
Photocopiers are practical, though they reproduce photographs badly and can become expensive for long print runs. Laser printers provide better quality, but the unit cost is higher still. Many newsletter editors use outside printers, who will make their plates from your laser printed copy; if you have a Postscript printer you can obtain a positive or negative from a bureau at about [pounds]5 a page, which gives a much sharper image.
Which method you choose will depend largely on your budget (a full colour eight page newsletter with a run of 3000 will cost about [pounds]1500-[pounds]2000 for printing alone), the equipment you have in house, and, most important, what your staff can operate.
Once you have decided on the means of production, construct your own production cycle (box). Produce schedules for the rest of the year, and you will know when to block off time. This should ensure that you publish your newsletter regularly.
The next stage is deciding how your finished publication will look--in other words, the design. Your final product should be simple and have its own identity or personality.
Remind yourself what you wish to achieve. Reread your mission statement, then work out the type of contents you will need to achieve your aim: news, features, letters, columns, editorials, small ads, etc. Decide on the number of pages you can afford and construct a master flat plan (fig 2). If you are using a professional designer this will comprise your brief.
Your newsletter must have the same structure issue after issue. We all like our favourite publications to be familiar. Those that have experimented by moving parts around have received a clear message from their readers: "We don't mind where you put things, but please stop moving them around."
A clear structure helps the editor as well as the reader. Many inexperienced editors use a scattergun approach, in which they ring up anyone who could possibly contribute, waste valuable time chasing them all up, and end up having far too much material. It is far more efficient to work out what you want for each page and then write or commission accordingly. This won't solve the problem of writers missing their deadlines, but it will ensure that chasing copy is directed to the right places.
Once you have the structure, decide on the style. Start with the masthead, or the publication's title. This should have four elements: (a) the publication's name, (b) an explanatory line (for example, "A monthly newsletter for patients of the Lupin Group practice"), (c) the date and issue number, and (d) the logo. One word about logos: you may not like yours (few people do) but you must use them for the sake of what marketing people would call your corporate image. It is worth going to a professional for this part of the publication: a local art school might welcome it as a project.
You should also consider your headers and footers--the lines or other graphical material at the top or bottom of each page. You can use these to replicate your title, reinforcing your newsletter's identity, or to denote certain parts of the newsletter, such as Letters, News, or Noticeboard.
Decide on the size of paper. Most people choose A4, which is familiar and convenient; choose another size only if you have a good reason. Coloured paper can help to build an identity, but make sure that it is pale enough to display the type clearly. Don't change the colour for each issue: you might understand that white comes with the February snow and green with the new grass in May, but the reader will not.
Work out how many columns you will use. There are two rules of thumb. Firstly, for ease of reading, use no more than about 50 characters in each line. Secondly, the more columns there are the more complicated the layouts; most wise but inexperienced newsletter editors choose two or three columns. White space is important: there should be adequate margins on all four sides so that the words are pleasantly framed.
Next comes typography. Resist polyfontophilia--the temptation to use all the fonts on your computer (fig 3). This may impress you, but it will confuse the readers. Select one typeface for the bulk of your text--the "body copy." Reading guidelines from the Royal National Institute for the Blind state that it doesn't really matter if you choose a serif face like Times or Palatino or sans serif face like Helvetica or Gill. But they stress that many publications use type that is too small. If most of the readers are aged over 40, the minimum typesize for body copy is 10. Make sure there is enough white space (leading) between the lines.
Some people use a bold version of the body type for headlines and other devices (display type). Others will use a completely different face. Both work, provided that you are consistent. If you want to vary the effect of headlines vary the size or lines of the type, not the typeface (fig 4). Don't be timid: a common fault is having headlines too small. Another is using capitals (see fig 3). Using white type on black boxes is an effective device for small boxes but is difficult to read and should be avoided for longer headlines.
Finally, work out a policy on illustrations. The general rule is: if you cannot afford to use them properly, don't use them at all. "Snaps" look amateurish, particularly when they cannot be properly reproduced. The "clip-art" images available in many software packages are technically fine, but they have become visual cliches. It is better to use other devices --such as good strong headlines, "pull out" quotations, and "shadow" boxes--to make a page look interesting. And it will be cheaper.
Write down these style points--and keep to them. This is the only way to build up your publication's personality.
You should now start thinking about the words for the first issue. Waiting until this stage makes the task less daunting: you now know what space you have to fill.
Do not try to write everything yourself. Using other contributors provides variation and gives you time for leadership tasks, such as inspiration and coordination. Be specific when you ask for contributions: give each writer a brief, a length, and a deadline and remind them of the target audience. If you ask someone to write a major article confirm this in writing. For several articles (for instance, to fill up a news page or a diary section) make sure that you arrange for regular progress reports.
You will soon find that your problem is not which topics to put in but which to leave out. Start listing items that you think will be interesting to your readers. Keep a diary of forthcoming events. Make sure that you receive--and read--as much relevant information as possible, such as minutes and circulars. Decide how each item should be treated--that is, in which section would they be best suited.
Take, for instance, the appointment of a new doctor. You could publish it as a service item, with one or two lines about the new appointment in a "New Faces" column. You could write it as a news story of 200-300 words, giving rather fuller details of the new appointee and the job he or she will be doing. You could run it as a 600-1200 word feature article, in which, for example, a contributor would interview the new person in some detail. Use your flatplan to help you decide the most appropriate treatment.
Do not blur fact with opinion. Saying that the new doctor is the best thing to hit the area since the eradication of smallpox may be valid, but it is not the role of a publication to say so (unless in an editorial). Instead, find a senior colleague and quote him or her. Attribute that comment clearly, and your readers will see you in your proper role of giving out information, not propaganda.
Newsletters must be seen in proportion. They are not documents of record or attempts to advance human knowledge. They are intended to provide a flow of basic information to busy people. This perspective can be difficult in a large organisation, when employees who write are always looking over their shoulders at their bosses or thinking of the possible political repercussions, but it is vital. Good newsletter writing succeeds when it successfully gets across worthwhile bits of information, which is not the same as covering all the angles--and the writer's back.
To this end paragraphs should be short, mainly because these are visually less daunting. Sentences should be short--aim for five or six sentences every 100 words--and logical. The words should also be short: use "start" and "pills" rather than "commence" and "medication." Whenever possible use the active rather than the passive. Avoid jargon.
Use quotes whenever you can: these add interest and colour and give you the chance to use opinions. Make sure that your opening paragraph is interesting. Unlike scientific papers, which keep the conclusions until the end, newsletter articles should attract attention immediately. They are competing with many other items for a reader's attention. Several books deal with the writing techniques needed.[2-4]
Deciding in principle whether to accept a submitted article is at the heart of the editing process. Once that decision is made, you will almost certainly need to make some changes to the submitted copy; that is the subediting function. It is important to make this distinction, even though the editor of a small newsletter may be doing both tasks.
The main purpose of subediting is to ensure that each accepted article has the greatest chance of being read. Apply the guidelines from the previous section. Check basic facts, particularly names and titles: readers will lose confidence if you write about Jeff Smith when they know it is Geoff Smyth; Mr Smyth may never talk to you again.
Eliminate potentially irritating inconsistencies of style. Readers can be put off by seeing "Dr" in one line and "Dr." in another; in such cases where there are real alternatives write down a house style--and keep to it (box). Apart from anything else this will cut down on the time spent arguing with pedants: you will be able to say that this is the house style, and that should be the end of the matter.
This will be particularly useful when it comes to the vexed question of initial capital letters. Most readership research shows that capital letters slow the reader down; they also look old fashioned. This does not deter supporters of the Pompous Initial Capital, who will insist that writing the medical management subcommittee without capitals somehow diminishes its status. Think of the reader, and ignore them.
The two main pitfalls are copyright and libel. In both cases your aim should be to avoid expensive rounds of solicitors' letters, and the best thing is to apply some common sense.
On copyright, avoid taking other people's work without permission. This applies to cartoons. If you want to use something that has been published elsewhere, write to the editor, who may well allow you to reproduce it without payment. As for libel, this occurs when you write something about someone that "lowers them in the eyes of right thinking members of society generally." It is a minefield, which keeps some lawyers extremely rich. The commonsense rule is don't be rude about someone. If you feel you must, then seek legal advice before you publish.
Subeditors are responsible for the look of individual pages, subject to the overall style. They will decide what goes where on each page, and mark up--or format--the copy accordingly. It is unlikely to fit perfectly, so don't be afraid to cut. Do not alter the style to make it fit, for example by reducing the typesize; this will destroy your newsletter's hardearned personality. Do not be afraid to add extra lines to stories so that they can fit exactly; often, adding extra paragraph breaks will do.
Now is the time to write headlines and other devices intended to attract the reader. Set the style before writing the headlines, which will dictate the size of the type and the number of lines. Put the most important (and logically the longest) story at the top of each page. Graduate the size and lines of headlines accordingly.
Headlines are not labels, but marketing tools. They should contain short, interesting words and, whenever possible, a verb. The top line should be longer than the second to draw the reader's eye down into the story. They should never contain information that is not in the story. Avoid whimsical or punning headlines on every story.
Newsletter editors find it hard to know how they are doing, but they should try. An obvious method is to send out a questionnaire with the publication, but response rates will be low. Editors must therefore monitor "Letters to the Editor," ask their readers for their opinions, or watch to see how quickly (or slowly) piles of their newsletters disappear. These are not scientific methods but are better than the alternative, which is listening to the opinions of a few people with axes to grind or who have little in common with your target readership. You will have complaints, but see them in perspective: newsletters must be judged on the overall flow of information they provide, not on individual items.
Throwing ill-considered newsletters at a communications problem will probably do more harm than good, and will certainly be a waste of resources. On the other hand, a newsletter that is well planned, adequately resourced, and skilfully executed will be a formidable communications tool. Enjoy it; if you do not, then how can you expect others to do so?
 Royal National Institute for the Blind. Making print legible--basic guidelines. London: RNIB Publications Unit, 1990.
 Strunk W, White EB. The elements of style. New York: Macmillan, 1959.
 Goodman NW, Edwards MB. Medical writing: a prescription for clarity. Cambridge: Cambridge University Press, 1991.
 Albert T. Medical journalism-the writer's guide. Oxford: Radcliffe Medical Press, 1992.