When the editor in chief reads every manuscript, something has to change

How JBJS - the 135-year-old gold standard of orthopaedic publishing - restructured editorial decision-making, shifted its content model, and tripled individual subscriptions. A masterclass in change management for senior media leaders.

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Editorial Governance B2B & Specialized Media

Imagine your editor in chief personally reviews every single manuscript that arrives at your journal. All 3,600 of them. Every year. Dense, 12-to-14-page scientific papers, packed with randomized control trial data, graphs, and statistical analysis.

That was the reality at JBJS (the Journal of Bone and Joint Surgery) - one of the most prestigious medical publications in the world - until just a couple of years ago. And while it worked for 125 years, it was quietly strangling the organization's capacity to grow.

In a recent webinar for senior B2B and specialized media leaders, JBJS CEO Jason Miller and Marketing Director Bev Waness laid out, with typical Renewd candour, exactly how the organisation rethought its editorial governance model - and what ripple effects followed across culture, staffing, content strategy, and revenue.

For any media executive navigating a transition in leadership, content model, or decision-making structure, what JBJS went through offers some hard-won lessons.

The problem with a model that "worked"

The traditional JBJS model was deeply personalized. One individual - the editor in chief - sat at the apex of every editorial decision. They read every submission, directed every team member, and maintained the standards that made JBJS the orthopaedic equivalent of the New England Journal of Medicine.

It wasn't broken, exactly. But it had a cost.

"The editor in chief had to connect with all levels of editorial. That person was responsible for doing the first read of every manuscript - 3,600 last year. Imagine the time."
- Jason Miller, CEO, JBJS

Reading 3,600 manuscripts a year left almost no room for external engagement. No time to travel, to meet orthopaedic surgeons at conferences, to be the face of the journal in the communities it served. In an era where relationships and reach increasingly determine relevance, this was a structural constraint hiding in plain sight.

The trigger for change came in 2024, when JBJS brought in a new editor in chief: Dr Mohit Bhandari, chair of surgery at McMaster University and - by most measures - the most cited orthopaedic surgeon in the world. Hiring someone of that profile and then asking them to spend their days reading desk submissions would have been, as Miller put it, "somewhat irresponsible."

So the model had to change.

Decision rights: from direction to empowerment

The shift JBJS made sounds simple but is culturally profound: moving from a directive model - where staff received clear instructions from a single authority - to an empowerment model, where team members owned their decisions and were accountable for outcomes.

What this looked like in practice

Under the old model, the question was always "what do I need to do?" Under the new model, the question became "what are we trying to achieve, and how do I get us there?" For an organization with decades of directional leadership embedded in its culture, that shift created visible turbulence.

"There were team members coming to me saying, 'I'm really trying, but I just don't know what the call is anymore.' And others stepping up saying, 'Hey, this is great - I can lead. I can find my voice.'"
- Bev Waness, Marketing Director, JBJS

The split response is predictable and, as both Miller and Waness acknowledged, entirely normal. What mattered was how the organization responded to each group - neither abandoning those struggling with ambiguity nor holding back those ready to step up.

Key governance shifts JBJS made

Removed the single-point editorial bottleneck at the top
Created an executive editorial council with distributed responsibility
Empowered team members to make decisions within their domains
Repositioned the editor in chief as external ambassador, not internal gatekeeper
Introduced clearer ownership of decision rights across the organization

The data that justified the change

One of the most valuable parts of the JBJS story for media leaders is how they built the case for change. It wasn't based on instinct or leadership preference - it was grounded in two specific data signals.

<20% of content driving over 80% of total usage

3× growth in individual subscriptions over four years

65% reduction in published output - intentionally

135+ years of brand heritage to protect through change

The first signal: less than 20% of JBJS output was generating more than 80% of usage. The long tail of scientific papers was reaching a shrinking pool of academic researchers - not the global community of practising orthopaedic surgeons the journal aspired to serve.

The second signal: the author pool itself was contracting, even as the global orthopaedic community grew. Geographically, JBJS was failing to attract submissions from outside its traditional Western academic base.

Together, these signals pointed in one direction: the journal was optimised for a version of its audience that represented perhaps 7–10% of all orthopaedic surgeons. A sustainable publishing business needs to do better than that.

Content strategy: from comprehensive to curated

The editorial restructuring enabled a content strategy shift that would have been impossible under the old model. Rather than attempting to publish broadly across every orthopaedic sub-specialty in every issue, JBJS made a deliberate choice: raise the bar on scientific content and fill the resulting space with content that meets the practising surgeon where they are.

Theme issues: a structural innovation

Perhaps the most significant content innovation was the introduction of quarterly themed issues. Rather than scattering content across hip, shoulder, spine, and knee in a single issue, JBJS now organizes entire issues around a single high-impact theme - infection in joint replacement, AI in orthopaedics, sports medicine timed to the World Cup.

The effect is cumulative. A shoulder surgeon in Romania picks up a theme issue on infection and finds it directly relevant to their practice. An academic in Thailand finds the sports medicine issue timed to a global moment they're already paying attention to. The journal stops being a resource for specialists and starts becoming essential reading for practitioners.

"When Mo stands up at a meeting in Lima and says he'd love a report on the important themes of this conference for the next issue - people fall out of their chairs. Not because the brand is desperate. Because it's finally inclusive."
- Jason Miller, CEO, JBJS

Community content alongside scientific rigour

JBJS didn't abandon scientific publishing - it elevated it. By reducing overall volume and raising the acceptance threshold for research papers, the journal paradoxically increased their impact. The space freed up was filled with regional reports, editorial commentary, and community-generated content that speaks to the daily reality of orthopaedic practice around the world.

Culture: the part no one talks about enough

Editorial restructuring is, at its heart, a culture change project. And JBJS's experience surfaces some of the dynamics that senior leaders often underestimate.

The "you're calling my baby ugly" problem

When staff have built their professional identity around a particular way of working - and that way of working has been validated for decades - change feels personal. Miller named this directly: many people heard the new direction as an implied criticism of everything they'd done before. Managing that emotional reality, not just the operational transition, is a core leadership task.

The "mistakes are not allowed" culture

Directive organizations often develop a paralysing relationship with failure. When every decision flows through one authority, individual contributors never build the muscle for independent decision-making - and they don't know how to handle the anxiety of being responsible for outcomes. JBJS had to explicitly reframe what mistakes meant: not a reason for removal, but a necessary part of acquiring judgment.

Miller's framework for staff struggling with empowerment

Step 1: Diagnose the root cause - is it lack of tools, or fear of failure?
Step 2: If tools, invest in training and skill-building
Step 3: If fear, name it clearly and reframe failure as growth
Step 4: For persistent resistance, offer honest, supported transitions - out of the role or out of the organization - with dignity

The value of a connector in the middle

One underappreciated factor in JBJS's change process was Waness herself - a senior marketing leader who sat outside the editorial hierarchy and could move between groups, translate between camps, and absorb the anxiety that accumulates during organizational transitions. In large change programmes, having a credible, connected individual who isn't directly threatened by the change is invaluable. She describes her role plainly: talking people off the ledge, repeatedly.

Resilience: why their timing turned out to be fortuitous

No publisher could have fully predicted the scale of reductions in scientific and academic research funding that began to emerge in 2025. But JBJS's restructuring - reducing reliance on high-volume scientific submissions, diversifying content types, building individual subscriber relationships - turned out to be well-suited to precisely that environment.

The 65% reduction in published output that was a deliberate editorial choice aligned, almost accidentally, with a market in which the volume of submission-ready research was declining anyway. And the threefold growth in individual subscriptions provided a revenue buffer as institutional library budgets came under pressure.

The lesson isn't that JBJS predicted the future. It's that organizations with genuine strategic clarity and flexible decision-making structures are better positioned to adapt when the environment shifts unexpectedly.

Five questions every specialized media leader should be asking

Lessons for senior media executives

Who actually has decision rights in your editorial process - and does that match your strategic ambition?
What percentage of your content is driving the majority of your audience engagement? What does that tell you?
Is your editor in chief (or equivalent) spending their time where your brand needs the most leverage?
When you empower staff to make decisions, have you addressed the fear of failure - or just removed the directive structure?
How diversified is your revenue and content model against a future where traditional institutional funding contracts further?

JBJS are clear that they're not at the final destination - they estimate they're around the halfway point of a genuine cultural transformation. But the markers of progress are real: new content models with demonstrable audience reach, a threefold growth in individual subscriptions, and a staff that, at least in part, has found its voice. As Miller put it: "We've had more success than failure, and we're determined we'll get there."

For specialized media leaders watching from the sidelines, the JBJS story is a reminder that the most enduring brands are the ones willing to honestly interrogate whether the model that made them great is still the model that will carry them forward.