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

Literature and Dictionary Definitions

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 Definitions

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: 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

Professionalism in healthcare requires a combination of abilities, knowledge and skill to provide services to patients. This is required for good treatment results while still focusing on patient safety. (reference)[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 Behaviours of Professionalism

Attributes, core competencies and behaviours of professionalism include:

• accountability
• dependability
• responsibility
• appreciation of duty
• selflessness
• commitment to excellence
• empathy
• truth
• honesty
• rectitude and integrity
• sensitivity to the needs of diverse populations
• adherence to ethical principles
• respect
• altruism
• collegiality
• continuous learning and improvement
• humility
  • healthcare professionals acknowledge that humility is key to high quality, interdisciplinary team-based, patient-centered careand professional humility can be a powerful force within healthcare when seen as a trait of strength and collectivity among colleagues.

"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)."

Prerequisite qualities for professionalism include:

• professional competence
• good communication skills
• trustworthy
• soft skills
• ethical codes

There seems to be an overlap between ethics and professionalism. Table 2 shows some of the overlapping principles and attributes of ethics and professionalism.

Table 2. Comparison between ethical principles and attributes of professionalism (adapted from Desai and Kapadia )

Ethical Principles	Professionalism Attributes
Autonomy: Respect the patient; Rights of patient to choose or refuse treatment; Patient involved in decision making	Respect, compassion, empathy
Beneficence: Decision should be made in the best interest of the patient	Altruism, commitment to excellence
Non-maleficence First do no harm	Care, sensitivity , responsiveness
Justice Fair selection and distribution of resources	Integrity, truth, honesty, accountability

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. Examples of unprofessional behaviours include:

• 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
    • Vertical violence - 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 used include sabotage, slander, petitions, votes of no confidence

• Toxic workplaces behaviours
  • Eye rolling
  • Sarcasm
  • Threats
  • Aggression
  • Withholding important patient information
  • Disrespect
  • Rude
  • Condescending remarks
  • Scapegoating

Drivers of Unprofessional Behaviour

Bhardwaj (2022) identifies some drivers of unprofessional behaviour. These are listed below.

• 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
• Unconscious bias
• Tolerance for aggression
• Ill recognition for performance
• Lack of opportunity for professional growth 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

Resources

• bulleted list
• x

or

1. numbered list
2. x