Professionalism in Healthcare

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Top Contributors - Wanda van Niekerk and Jess Bell  

Introduction

Professionalism is an important but complex concept in healthcare. A multitude of studies on the definition of professionalism in healthcare highlights this complexity. It is clear though that without professionalism the quality of healthcare, patient and illness outcomes, patient safety and trust between healthcare professionals are negatively affected.

Definitions of Professionalism in Healthcare

Some definitions of professionalism as found in the literature are seen in Table 1.

Table 1. Definitions of professionalism found in the literature

Source	Definition
Merriam Webster Dictionary	"the conduct, aims or qualities that characterise or mark a profession or a professional person"
Cambridge Dictionary	"the combination of all the qualities that are connected with trained and skilled people"
Desai and Kapadia	"the attributes, behaviours, responsibilities, principles and objectives that characterise a profession or professional person. It implies the quality of service.”
Epstein and Hundert	"Professional competence is the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotion, values and reflections in daily practice for the benefit of the individual and community"

Healthcare Professional Regulatory Bodies and Professionalism

It is best to consult your specific professional body in your country about their definition of professionalism. Below are links to some professional bodies' view on professionalism.

• Chartered Society of Physiotherapy: What is Professionalism
• World Physiotherapy: Ethical principles and the responsibilities of physiotherapists and member organisations
• American Pharmaceutical Association Academy of Students of Pharmacy: White paper on pharmacy student professionalism
• General Medical Council (UK): Domain 4: Trust and professionalism
• New Zealand Nurses Organisation: Standards of professional nursing practice
• American Academy of Physical Medicine and Rehabilitation: Professionalism in rehabilitation: Peer, student, resident and fellow recommendations / assessment
• Australian Occupational Therapy: Competency standards
• Australian Orthotic Prosthetic Association: Ethical principles and code of professional conduct
• Royal College of Occupational Therapists: Professional standards for occupational therapy practice, conduct and ethics
• European Speech and Language Therapy Association: Professional profile

It is a combination of having abilities, knowledge and skills which are sufficient to work and provide services to patients and those on the receiving end of the health service. This is in order to efficiently achieve good treatment results while ensuring safety in receiving such services.

Attributes and behaviour of professionalism include:

Accountability

Selflessness,

Commitment to excel

Empathy

Truth

Admiration

Sensitivity to the needs of diverse populations

Adherence to ethical principles

Professionalism is defined as (ref no 3) In other words, professionalism emphasises humanistic aspects (attitude, behaviour, virtues and characteristics)desirable among healthcare professionals in all circumstances in addition to biomedical aspects (knowledge, clinical reasoning and technical skill)

Prerequisites qualities for professionalism include:

Professional competence

Good communication skills

Trustworthy

Soft skills

Ethical

Desai MK, Kapadia JD. Medical professionalism and ethics. Journal of Pharmacology and Pharmacotherapeutics. 2022 Jun;13(2):113-8.

Overlap Ethics and Proffessionalism

Ethical Principles Professionalism Table 2

Autonomy:

Different organisations and links to their sites

Professionism as defined by different groups of healthcare students

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Professional Behaviour in healthcare

Core competencies expected in the delivery of healthcare services are: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.tandfonline.com/doi/pdf/10.2147/JHL.S383069

Altruism

Dependability

Responsibility

Quest for excellence

Appreciation of duty

Agency

Honesty

Rectitude and integrity

Collegiality

Respect for others

Continuous learning and improvement

humility

Unprofessional behaviour

Unfortunately in the clinical workplace, many healthcare professionals experience and perceive unprofessional behaviour. In a study investigating the type and frequency of perceived unprofessional behaviours among healthcare professionals it was found that 63 % experience unprofessional behaviour at least once a month. This includes behaviour such as professionals not responding to calls / requests, being excluded form decision-making and blaming behaviour. Dabekaussen KF, Scheepers RA, Heineman E, Haber AL, Lombarts KM, Jaarsma DA, Shapiro J. Health care professionals’ perceptions of unprofessional behaviour in the clinical workplace. PLoS One. 2023 Jan 19;18(1):e0280444.

Examples Unprofessional behaviours

Bullying

Defined according to direction

Lateral violence – professional against professional

Vertical violence – bullying from the top

Employers against employees

Unfair work practices

Abuse of power

Bullying from the bottom up

Employers against employees

Strikes / work slow downs

Refusal to follow procedures

Mobbing – group “ganging up” on an individual with goal to remove individual from group or intimidating individual

Methods – sabotage, slander, petitions, votes of no confidence

Toxic workplaces behaviours

Eye rolling

Sarcasm

Threats

Aggression

Withholding important patient information

Disrespect

Rude

Condescending remarks

Scapegoating

MacLean L, Coombs C, Breda K. Unprofessional workplace conduct... defining and defusing it. Nursing Management. 2016 Sep 1;47(9):30-4.

file:///C:/Users/wanda/Downloads/unprofessional_workplace_conduct___defining_and.8.pdf

Drivers of unprofessional behaviourBhardwaj A. Medical professionalism in the provision of clinical care in healthcare organizations. Journal of Healthcare Leadership. 2022 Jan 1:183-9.

High or extra workload due to limited staff or resources

Chronic fatigue

Sleep deprivation

Burnout

Low self-esteem

Personal stressors such as difficult relationships

Unsupportive leadership

Inadequate supervision

Poor organizational culture and work environment

Tolerance of unprofessional behaviour

Bigotry

Bias unconscious

Tolerance for aggression

Ill recognition for performance

Lack of opportunity for professional growh and development

Lack of social support systems

Limited or constricted resources

Loss of autonomy and decision-making capabilities

Toxic and substance abuse

Patient perspectives on the professionalism of healthcare professionals

Regis, Steiner, Ford, Byerly have highlighted some aspects of professionalism that are highly regarded and valued by patients. These include:

Good communication

Caring attitude

Honesty

Attitude

Research into patient perspectives on the professionalism in healthcare providers have identifies four interconnected themes that describes professionalism from a patient perspective. Bulk LY, Drynan D, Murphy S, Gerber P, Bezati R, Trivett S, Jarus T. Patient perspectives: four pillars of professionalism. Patient Experience Journal. 2019;6(3):74-81.

Taking a collaborative human-first approach

Key aspects of this theme are that patients should be

perceived as a complex human who deserves to be treated as a priority

And

A vital part of the interdisciplinary team

Summary by a patient on their view of professionalism

“It’s important for people, even if they’ve been in practice a long time, to maintain some sense of humility in the face of their patient. They don’t know what it is to be the patient and to live with whatever that is that their patient has.

Clinicians must patients as humans above all so that they maintain a collaborative person-first approach to care”

Read more about person-centered care

Communicating with heart and mind

Clinicians should communicate with the hearth through demonstrating emotion and empathy and with the head through clinical reasoning and applying their clinical knowledge.

Aspects of communication that are important to patients are:

Listening

Be attentive

Implicit Communication skills such using understandable language

Clinicians should be polite and respectful,ability to develop a rapport with a patient

“Effective communication must balance pertinent information. Explicit skills (listening, building rapport, caring) and implicit skills (come from the heart, empathy)

Patients want clinicians to “think about what the patient is hearing”

Behaving with integrity

Patients expect clinicians to tell the truth

Clinicians should maintain professional boundaries

Adhere to ethical standard and maintain confidentiality

Patients ask of clinicians to be honest even if clinicians need to admit that they are uncertain or don’t have the answers. As long as they are willing to take action around their limitation in knowledge to allow for optimal care of the patient.

Practicing competently

Patients assume that their healthcare professionals are competent.  This competence encompasses skill and knowledge, appropriate education and the correct licensing to practice their profession.

Frameworks

Medical Professional Framework

Eight identified components of professionalism in healthcare professionals

Humanism

Communication

Acountability

Ethics

Clinical competence

Altruism

Excellence

Integrity

CanMeds Framework

Seven different roles

Professional

Communicator

Scholar

Collaborator

Health advocate

Leader

Professional Bodies and the Description of Professionalism

We recommend that you consult with your country’s professional body on their definition and guidelines on professionalism. The professional bodies below are used as examples

Chartered Society of Physiotherapy (CSP) in the United Kingdom What is Professionalism (https://www.csp.org.uk/content/what-professionalism )

World Physiotherapy Ethical principles and the responsibilities of physiotherapists and member organisations Policy statement (https://world.physio/sites/default/files/2022-03/PS-2022-Ethical_responsibilities_principles_Eng.pdf )

Pharmacy White Paper on Pharmacy Student Professionalism https://www.ttuhsc.edu/pharmacy/documents/administration/professional-affairs/whitepaper.pdf

General Medical Council in the UK

Royal College of Occupational Therapy Professional standards for occupational therapy, practice and ethic

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