The document provides background on the American College of Chest Physicians' (ACCP) publication CHEST and their strategy to expand into China. It discusses CHEST's vital statistics and history of international editions. The goals of the China strategy were to promote the brand, increase revenue and membership, and develop relationships. Initial results included growing the translated edition's circulation to over 8,000, increasing institutional subscriptions and China/Hong Kong membership significantly, and modest growth in meeting attendance and submissions. Lessons learned included being patient, properly planning and budgeting, choosing partners wisely, and the importance of in-person visits.

1. China 101: Case Study
American College of Chest Physicians/CHEST
Stephen J. Welch
Executive Editor, CHEST
Vice President, Communications

2. China 101: Case Study
AKA: Swim With the Sharks but Don’t Get Bit;
In fact it’s quite possible to Thrive
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3. Objectives
• Background on ACCP (Publisher)
• Vital Statistics of CHEST
• Discuss International Development
• Why China?
• What were/are our goals?
• How are we doing?
• Lessons learned

4. ACCP and CHEST Vital Statistics
• Self-published since 1935 by ACCP
• Circulation: ~20,000
– ~16,000 ACCP members (20% Int’l)
– ~4,000 subscribers (50% Int’l)
• Distributed into 100+ countries
• Heavily clinical -- lots of asthma,
COPD, respiratory infections, lung
cancer, etc

5. CHEST Overview
• Submissions: 3200 manuscripts per year
• Impact Factor: 3rd out of 33 Respiratory Journals
• 2nd in # of total citations
• Ok for a clinical journal
• Advertising is strong
• CHEST is tops in its field in Market Share

6. Manuscript submission statistics
Current Submissions:
• 31% from USA
• 3% from Canada
• 66% from Int’l
– 1.5% to 2% from China
Accepted/Published papers:
• 37% US, 4% Canada, 59% Int’l
These numbers have reversed since 2003
(online submission)

7. CHEST % of Manuscripts PUBLISHED by Region
Accepted Manuscripts, %
4%
International
59%
US
37% Canada

8. CHEST International Editions
CHEST Had International Translated Editions in These Countries:
– Spain (regular edition and pediatric edition)
– Mexico (regular and pediatric edition)
– Italy
– Turkey
– India (English language)
– So in 2003 we started looking at China
– Investigating others (sorry that info is classified)
– Failed editions: Russian, Portuguese
• These things don’t always work the way we’d like…

9. Starting an International Edition:
Steps Involved
1. Identify Region(s) where you want to develop editions
• Part of an international business plan
2. Select a translation partner
• Must be reliable, professional (your reputation is at stake!)
3. Develop a contract
• Who is responsible for what -- all the legal fun stuff
• Disclaimers, length of term, # of pages published, etc
• Financing (Industry sponsored vs subscription based)
• Royalties to your organization
• Other (house ads?, who will receive it, etc)
4. Identify the Editor (must be a CHAMPION!)
• Our Editor (and board members) are MEMBERS of ACCP
5. Appoint Editorial Board (select articles to translate)
• Articles should be for the readers, not the sponsors

10. China Development: Why China?
Why focus on China for society publishing business
development?
– WORLD DOMINATION!!!!
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11. China Development: Why China?
Why focus on China for society business development?
• Growth
a) Financial (we’re a not-for-profit, but a greedy one!)
b) Organizational (studies show a US specialist workforce shortage is
imminent; that means fewer US members)
c) Sales and distribution (reach) of products and services
• Mission
a) Get CHEST into the hands of population with health problems
b) Help promote humanitarian awards of our Foundation
• Member Needs -- 2003 visit resulted in requests for:
a) Chinese language edition
b) Help with translation and getting published
c) Educational programs
d) More robust membership (HK chapter was very successful)

12. China Development: Why Now??
Q: Why Focus on China now? Why not wait?
A: Because it takes TIME
Be Prepared to spend:
– a lot of time
– a lot of money
Be prepared to wait a while for any ROI
Be prepared to face your critics

13. China Development: Why Now??
Considerations and arguments for doing it sooner not later:
– Huge population (physicians and consumer public)
• This = potential customers
– Large number of institutions
• More potential customers
• 2 major consortia: CALIS and NSTL
– Pharma development and involvement is increasing quickly
– Great desire for Western medical information
– Great pressure to publish in English language journals
– Language barrier is improving (slowly)
– Economic barriers are improving (slowly)
• Note: Financial transactions can be problematic; must go through a
government approved company that can handle money

14. China Development: Goals
1. Promote Brand Identity & Awareness of CHEST
and ACCP
– Awareness: Get CHEST into the hands of people who may
not be familiar with it -- and deliver key articles in their
native languages
– Increase ACCP membership
• Lower cost e-membership
• Low-cost membership for physicians in training
– Increase meeting attendance
• Target submission of abstracts
– Marketing: ACCP products (books, CDs, etc) and educational
courses
– Increase manuscript submissions of key regional
researchers
– Involve local members in projects

15. China Development: Goals
2. Financial QuickTime™ and a
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– Generate royalty revenue from licensing the content
– Increase subscriptions to CHEST
• Individuals (via membership)
• Institutions
– Develop relationships with international pharmaceutical
companies
• Grants
• Sponsorships
• Other projects
– Grow society revenues from membership dues, meeting
attendance fees, product sales

16. China Development: Goals
3. Develop Key Personal Relationships
– Give leaders and members in other
countries a sense of ownership through
journal projects and other participation
– Identify key leaders and future leaders
for ACCP
– Leverage relationships for other future
projects
• Membership development
• International courses QuickTime™ and a
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– Woo potential authors to submit
research to CHEST

17. China Strategy: A Step-Wise Approach
• Develop Translated Edition of CHEST in China
– Identified Everwell as Publisher
– Named highly respected, famous local leader as Editor in Chief,
appointed local editorial board (serendipity is good!)
– Launched in 2004
– Published monthly (8-10 articles), advertising based, breaking even
• Use Translated Edition as Marketing Vehicle
– Ads for membership
– Ads for products
– Ads for meetings
– Potential mailing list
• Hold Writing/Publishing Workshops Branded to CHEST
• Begin Targeting Subscriptions and Product Sales
– Hired Charlesworth in January 2007 as sales agent in China
– Plan to utilize Beijing Book Fair to promote books, products
• Offer a low-cost print-only reprint through XWPC

18. CHEST Results
How have our
China efforts
done so far?

19. China Outcomes
• China Edition Circulation: 8,000+
• Institutional Subscriptions: 40+
• Working on consortia deals
• Managing current China subscriptions much better
• Membership 2003 vs 2007
– China: 8 → 59 (+51 = +600%)
– Hong Kong: 81 → 130 (+49 = +60%)
• Meeting Attendance 2003 vs 2006
– China: 3 → 5 (+2)
– Hong Kong: 9 → 9 (no change, although this varies)
• Meeting Abstract Submission
– Fluctuating, no clear pattern yet

20. China Outcomes
Abstract Submission 2004-2007
25 23
20
15 11 13
China
10 8 Hong Kong
5
4
5 3
1
0
2004 2005 2006 2007

21. CHEST Results
• Financial
– Too early to have detailed results but membership $$ are
up
• Manuscript Submissions
– # of Chinese submissions are increasing
– Quality is increasing
• Involving Local ACCP Members
– EIC of China Edition, Ed Board are Members
– May involve members as faculty in future workshops or
courses
– Have developed strong personal relationships with
leaders (just invited to attend conference organized by a
China Ed Board member)

22. China Strategy: Other Considerations
• Politics
– Hierarchy of current medical system
• Old guard and young turks
• Traditions (Negotiations take TIME)
• Cost of Building Relationships
– Face-to-Face is important but cost $$$$
• Publishing: CN Code
– If you don’t go through CMA, getting one can be
very problematic
• Can China Model Be Replicated and Applied
to Other Countries?

23. Summary and Lessons Learned
• Be Patient
• Prepare to have to spend money to make
money
• Have a business plan and a budget
• Choose your partners wisely
• Financial transactions must go through
proper channels
• Make visits -- face-to-face time is VERY
important

24. THANK YOU!
CHEST International Edition Report
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Any Questions??
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