Instituting a culture of professionalism

There is a growing recognition that in health care institutions where professionalism is not embraced and expectations of acceptable behaviors are not clear and enforced, an increase in medical errors and adverse events and a deterioration in safe working conditions can occur. In 2008 Brigham and Women's Hospital (BWH) created the Center for Professionalism and Peer Support (CPPS) and has seen tremendous success in this initiative. Researchers recently analyzed data from the CPPS from 2010 through 2013 and found that employees continue to turn to the center for help, receiving reports about concerns regarding 201 physician/scientist and 8 heath care teams. These findings are published last week in The Joint Commission Journal on Quality and Patient Safety.

"These findings suggest that we have made substantial progress in professionalism with the creation of our center and that its popularity continues to grow," explained Jo Shapiro, MD, FACS, director of the CPPS and lead author of this study. "Our analysis also shows that our processes for responding to professionalism concerns have been able to address, and most often alter, repetitive unprofessional behavior in a substantive and beneficial manner."

The researchers evaluated the development of the Center for Professionalism and Peer Support and the results of the programmatic initiative at BWH that were put in place to educate the hospital community regarding professionalism and well as the process for managing lapses. For this article the researchers analyzed all concerns reported to the CPPS from January 1, 2010 through June 30, 2013. During this time the CPPS received reports of 201 physician/scientists and 8 health care teams about whom concerns were raised. The concerns were categorized by behavior that was, uncollegial, shirking responsibilities, hypercritical, demeaning, angry and others. The researchers also found that the interventions used in each specific case were in most cases successful in creating substantive changes in behavior. Interventions included: feedback, professional behavior coaching, conflict resolution programs, mental health support for emotional stresses and others.

"Our intention in creating the CPPS was, above all, to create a supportive professional community, explained Shapiro. "Our findings indicate that not only are employees bringing concerns to the center, but the interventions used in each case are changing behavior in a substantive and beneficial manner," explained Shapiro.

Initiating and sustaining changes in professional relationships requires a significant and ongoing institutional commitment to cultural change. Researchers note that future work is needed to more carefully categorize different types of unprofessional behavior, track the most appropriate and effective modification strategies and identify methods for conflict resolution and team training.

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