Professionalism in Healthcare

Original Editor - Wanda van Niekerk based on the course by Benita Olivier

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"

Defining Professionalism Difficulties

Bossers et al. described professionalism according to "encompassed parameters, behaviours and responsibilities." Conceptualised themes in their definition were "what we know, how we behave and ways in which we are accountable."

• Professional parameters
  • legal issues
  • ethics
  • morality
• Professional behaviour
  • skills
  • relationships
  • presentation
• Professional responsibilities
  • to the profession
  • to self
  • to the community
  • to the employer
  • to the client

Professionalism versus Professional Behaviour

Mason and Mathieson distinguishes between professionalism and professional behaviour as follows:

"Professionalism is more intangible and subjective, affected by a context-specific nature and generational interpretation of values, while professional behaviours are observable and more concrete."

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 et al. 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.

1. 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. One patient summarises it as follows: “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.” You can read more about person-centered care here.
2. 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, attentiveness, using implicit communication skills such as using understandable language. Clinicians should be polite and respectful and build on their 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.)
3. Behaving with integrity. Patients expect clinicians to tell the truth. Clinicians should maintain professional boundaries and adhere to ethical standards 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).
4. 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.

Professionalism Frameworks

Medical Professional Framework

The medical professional framework includes eight identified components of professionalism in healthcare professionals.

• Humanism
• Communication
• Accountability
• Ethics
• Clinical competence
• Altruism
• Excellence
• Integrity

The CANMeds Framework

The CANMeds framework describes the abilities healthcare professionals need. The seven roles are:

• Professional
• Communicator
• Scholar
• Collaborator
• Health advocate
• Leader

You can read more about the CANMeds framework here.