Instituting a Culture of Professionalism: The Establishment of a Center for Professionalism and Peer Support

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Article-at-a-Glance

Background

There is growing recognition that an environment in which professionalism is not embraced, or where expectations of acceptable behaviors are not clear and enforced, can result in medical errors, adverse events, and unsafe work conditions.

Methods

The Center for Professionalism and Peer Support (CPPS) was created in 2008 at Brigham and Women’s Hospital (BWH), Boston, to educate the hospital community regarding professionalism and manage unprofessional behavior. CPPS includes the professionalism initiative, a disclosure and apology process, peer and defendant support programs, and wellness programs. Leadership support, establishing behavioral expectations and assessments, emphasizing communication engagement and skills training, and creating a process for intake of professionalism concerns were all critical in developing and implementing an effective professionalism program. The process for assessing and responding to concerns includes management of professionalism concerns, an assessment process, and remediation and monitoring.

Results

Since 2005, thousands of physicians, scientists, nurse practitioners, and physician assistants have been trained in educational programs to support the identification, prevention, and management of unprofessional behavior. For January 1, 2010, through June 30, 2013, concerns were raised regarding 201 physicians/scientists and 8 health care teams.

Conclusions

The results suggest that mandatory education sessions on professional development are successful in engaging physicians and scientists in discussing and participating in an enhanced professionalism culture, and that the processes for responding to professionalism concerns have been able to address, and most often alter, repetitive unprofessional behavior in a substantive and beneficial manner.

Section snippets

Setting

BWM, a 793-bed tertiary care facility, serves as a major teaching hospital of Harvard Medical School. The physician and scientist faculty is composed of 2,738 individuals (1,630 [60%] men and 1,108 [40%] women), who represent 13 major specialty departments. The number of faculty at each rank includes instructor, 1,434 (52%); assistant professor, 638 (23%); associate professor, 395 (14%); and professor, 271 (10%).

Establishing the Center for Professionalism and Peer Support

In 2008 we established the CPPS to strengthen and support a culture of trust explicitly predicated on mutual respect for individuals, teams, the institution, and patients and their families. The mission of the CPPS is to encourage a culture that values and promotes mutual respect, trust, and teamwork. To achieve this, we established several key programs, including the professionalism initiative, a disclosure and apology process, peer and defendant support programs, and wellness programs (Figure

Participant Evaluation of Professionalism Training Sessions

At the conclusion of the mandatory professionalism training sessions, participants are asked to complete an evaluation indicating their professional role (for example, training level) and provide an assessment (for example, 1 = “strongly agree”; 5 = “strongly disagree”) of three elements: (1) whether the objectives of the session were met (for example, accepting their responsibility in supporting the institution’s professionalism culture), (2) whether the session improved their understanding of

Discussion

Our intention in creating the CPPS was, above all, to create a more supportive professional community, one in which we can, as Walsh stated, “begin to define and experience leadership as a collective project that derives its power and authority from a cooperative attachment to mutually defined commitments and values.”32(p. 24) Our findings indicate that mandatory education sessions on professional development are successful in engaging physicians and scientists in discussing and participating

Conclusions

Initiating and sustaining changes in professional relationships requires a significant and sustained commitment to cultural change. We have made substantial progress in professionalism with the creation of our Center for Professionalism and Peer Support, which includes a code of conduct; mandatory educational programs; and a robust reporting, assessment, and management process for handling concerns regarding professionalism lapses. Future work is needed to more carefully categorize different

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