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Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary (2014)

Chapter:II.3 Interprofessional Professionalism: Linking Professionalism and Interprofessional Care--Matthew C. Holtman, Jody S. Frost, Dana P. Hammer, Kathy McGuinn, and Loretta M. Nunez

« Previous: II.2 Professionalism and Medicine's Social Contract--Richard L. Cruess and Sylvia R. Cruess
Suggested Citation:"II.3 Interprofessional Professionalism: Linking Professionalism and Interprofessional Care--Matthew C. Holtman, Jody S. Frost, Dana P. Hammer, Kathy McGuinn, and Loretta M. Nunez." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
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William Sullivan, a social scientist who is a firm believer in the presence of a social contract between medicine and society, is worth quoting to close this paper. “The expectations of high standards of competence coupled with public responsibility have been established in large measure through the profession’s own efforts during the past century to establish secure social contracts with the public. The contract has been worked out gradually in statute and custom. In the process professionalism has evolved as a social ideal” (Sullivan, 2005). Negotiating the social contract within this context should be a principal objective of the medical profession and can assist the profession as it attempts to meet the ideal.

II.3 INTERPROFESSIONAL PROFESSIONALISM: LINKING PROFESSIONALISM AND INTERPROFESSIONAL CARE2,3

Matthew C. Holtman, Ph.D.
ICF International, Health, Education and Social Programs

Jody S. Frost, P.T., D.P.T., Ph.D.
American Physical Therapy Association

Dana P. Hammer, Ph.D., Pharm.D.
Department of Pharmacy, University of Washington, Seattle

Kathy McGuinn, M.S.N., R.N.
American Association of Colleges of Nursing

Loretta M. Nunez, Au.D., M.A.
American Speech-Language-Hearing Association

Introduction

Professionalism has typically been defined as a set of noncognitive characteristics (such as empathy) or as a set of humanistic values and behaviors through which clinicians express a commitment to excellence and compas-

________________

2 Reprinted from Journal of Interprofessional Care 25:383–385 (2011).

3 The authors wish to acknowledge the members of the Interprofessional Professionalism Collaborative (IPC), whose unique and ongoing collaboration has laid the conceptual groundwork for this paper. The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper. To learn more about the IPC, visit http://interprofessionalprofessionalism.weebly.com.

Suggested Citation:"II.3 Interprofessional Professionalism: Linking Professionalism and Interprofessional Care--Matthew C. Holtman, Jody S. Frost, Dana P. Hammer, Kathy McGuinn, and Loretta M. Nunez." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
×

sion (Stern, 2006). Its importance is underscored by the widespread adoption of language and policies by associations, accreditors, and regulatory agencies across the health professions that require clinicians to be trained and assessed on professionalism (Greiner and Knebwl, 2003). Yet, a critical conceptual gap remains in defining how professionalism contributes to improved patient outcomes, especially in the context of interprofessional care environments.

Elucidation of the link between professionalism and interprofessional care is an important issue to examine. Although contemporary clinicians do not practice in social isolation, development of the professionalism concept has neglected its link to collaborative care. In the contemporary context, professionalism contributes to safe, high-quality care primarily by supporting and fostering effective interprofessional care (Gilbert et al., 2010). We believe that persistent disciplinary insularity in health professions education has prevented this connection from being adequately emphasized.

The Interprofessional Professionalism Collaborative

In 2006, representatives of seven American national professional and educational groups convened to explore the concept of professionalism that could transcend and bridge the health-care professions. The group’s initial motivation was to identify or develop public-domain educational and assessment tools to promote professionalism. The group quickly recognized that there were many parallel, overlapping efforts to support professionalism within professions, but that little work had been done to develop a shared professionalism framework across professions. By 2009, the group expanded to 11 organizations representing 10 doctoral health professions: optometry, dentistry, psychology, veterinary medicine, pharmacy, physical therapy, audiology, nursing, and allopathic and osteopathic medicine. Currently, this group is called the Interprofessional Professionalism Collaborative (IPC) (Clark, 2006). The IPC began to focus on defining interprofessional professionalism and identifying its behavioral components. Though the group was kept small to foster interaction, collaboration, and consensus building, an effort was made to include a broad range of health professions to ensure the generality of the resulting model. It was expected that there would be opportunities for feedback and contributions from other professions through presentations, discussions, surveys, and publications.

Interprofessional Professionalism

The terms “interprofessionalism” and “interprofessional health care” are used primarily to describe the delivery of care by members of differ-

Suggested Citation:"II.3 Interprofessional Professionalism: Linking Professionalism and Interprofessional Care--Matthew C. Holtman, Jody S. Frost, Dana P. Hammer, Kathy McGuinn, and Loretta M. Nunez." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
×

ent health professions (Stern, 2006). Although these concepts describe the interactions between health professionals as the context in which interprofessional professionalism arises, they do not capture the idea of this distinct phenomenon in its entirety.

Likewise, “interprofessional professionalism” is distinct from professionalism. Professionalism, as defined within disciplinary “silos,” can be misused to justify unchallenged autonomy and can inhibit cooperation across professional boundaries. Interprofessional professionalism, in contrast, is a transcendent phenomenon that works across the professions to support coordination in communication and care for the benefit of patients, clients, and families.

Interprofessional professionalism overlaps conceptually with broader definitions of professionalism, and it builds upon previous research on team functioning, interprofessional education (McNair, 2005; Clark, 2006), interprofessional care, and relational coordination (Gittell et al., 2008). The IPC’s goal is to develop and articulate those elements of professionalism that are uniquely relevant to collaboration across health professions.

The IPC’s vision is that when interprofessional professionalism is practiced by all professions, it will improve health care quality and outcomes for patients/clients, will promote a culture that values and fosters individual competence, and will enhance education and practice environments. Borrowing language from Stern (2006), the IPC defines “interprofessional professionalism” as

consistent demonstration of core values evidenced by professionals working together, aspiring to and wisely applying principles of altruism, excellence, caring, ethics, respect, communication, and accountability to achieve optimal health and wellness in individuals and communities.

Though these concepts appear in various definitions of professionalism created within professions, interprofessional professionalism provides a different emphasis that underscores communication, collaboration, and negotiation across professional boundaries. This emphasis highlights professionalism as a resource for promoting skills, values, and organizational structures that facilitate interprofessional care. Interprofessional professionalism is distinct in focusing on competencies, values, and norms that multiple professions have identified as critical to promote effective interactions in the provision of care. The vignette in Box II-1 describes a health-care scenario that exemplifies interprofessional professionalism in action.

Professionalism is not an end in itself, but supports the ultimate goals of patient/client/family-centered care, quality, and patient safety. While broader discussions of professionalism frequently endorse these outcomes, they seldom emphasize cooperation among members of multiple health

Suggested Citation:"II.3 Interprofessional Professionalism: Linking Professionalism and Interprofessional Care--Matthew C. Holtman, Jody S. Frost, Dana P. Hammer, Kathy McGuinn, and Loretta M. Nunez." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
×

BOX II-1
Interprofessional Professionalism Vignette

A team of health professionals consisting of an internist, nurse, dentist, physical therapist, optometrist, and nutritionist are collaboratively managing [patient] JP’s obesity and diabetes care with secondary complications related to dental, visual, and skin integumentary conditions. The team is a shared collaborative in which leadership of and membership within the team are not based on hierarchy or profession but shift in response to JP’s needs.

Recently, an ethical dilemma has surfaced among the health professionals in relation to the management of JP’s care. Following a health crisis, one of JP’s practitioners has become frustrated and communicated to the team that she proposes to “fire” JP for poor adherence to his treatment. When challenged about this decision, the practitioner argues that she does not have time to deal with “patients who are not interested in helping themselves.” While the team members respect and value each others’ professional autonomy, expertise, and cultures, they identify that a candid dialogue about this ethical concern is warranted. Subsequent discussion reveals that an additional, though not critical, concern is that the patient is unable to pay for his care. Because the practitioner in question is a partner in a small practice with limited resources, she is frequently under pressure from other partners to drop patients who cannot pay for services. She believes that she cannot ethically divert resources from “more deserving” patients to JP, who does not appear to be committed to getting better. Some individual members of the care team vehemently disagree with this posture. But rather than requiring each team member individually to make adjustments to deal with the implications of the decision, the team takes a collaborative approach to this problem. During a conference call, the team members openly discuss the situation and begin exploring alternative arrangements that can be made to provide JP with the needed care.

One of the team members proposes to have a frank discussion with JP about his needs, goals, and resources. JP’s low income and low educational status emerge as significant contributing factors to his poor adherence to treatment. He cannot afford his medication, does not understand how it works, and therefore only takes it sporadically. He also has poor nutrition and limited opportunities to exercise. In an e-mail exchange, these problems are raised and the team discusses how failure to address JP’s socioeconomic issues may now be detrimental to his care. The team elects to shift priorities, resulting in a plan of care that is based on a more realistic assessment of JP’s goals, needs, and resources. The clinician who wants to drop JP is undeterred; however, one of the team members persuades her to continue care until JP can be referred to a different practice. Others help JP enroll in affordable and accessible community-based education and health services to help him manage his care more effectively. Once a practice is found that will accept JP as a new patient, the team builds ties with the new care providers, explains JP’s clinical history, and integrates the new providers into the team’s ongoing activities to implement the new plan of care.

Suggested Citation:"II.3 Interprofessional Professionalism: Linking Professionalism and Interprofessional Care--Matthew C. Holtman, Jody S. Frost, Dana P. Hammer, Kathy McGuinn, and Loretta M. Nunez." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
×
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Suggested Citation:"II.3 Interprofessional Professionalism: Linking Professionalism and Interprofessional Care--Matthew C. Holtman, Jody S. Frost, Dana P. Hammer, Kathy McGuinn, and Loretta M. Nunez." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
×
Page87
Suggested Citation:"II.3 Interprofessional Professionalism: Linking Professionalism and Interprofessional Care--Matthew C. Holtman, Jody S. Frost, Dana P. Hammer, Kathy McGuinn, and Loretta M. Nunez." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
×
Page88
Suggested Citation:"II.3 Interprofessional Professionalism: Linking Professionalism and Interprofessional Care--Matthew C. Holtman, Jody S. Frost, Dana P. Hammer, Kathy McGuinn, and Loretta M. Nunez." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
×
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Next: II.4 A Patient Perspective--Barbara L. Kornblau »
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Establishing Transdisciplinary Professionalism for Improving Health Outcomes is a summary of a workshop convened by the Institute of Medicine Global Forum on Innovation in Health Professional Education to explore the possibility of whether different professions can come together and whether a dialogue with society on professionalism is possible. Most of the 59 members making up the Global Forum were present at the workshop and engaged with outside participants in active dialogue around issues related to professionalism and how the different professions might work effectively together and with society in creating a social contract. The structure of the workshop involved large plenary discussions, facilitated table conversations, and small-group breakout sessions. In this way, the members - representing multiple sectors, countries, health professions, and educational associations - had numerous opportunities to share their own perspectives on transdisciplinary professionalism as well as hear the opinions of subject matter experts and the general public.

Efforts to improve patient care and population health are traditional tenets of all the health professions, as is a focus on professionalism. But in a time of rapidly changing environments and evolving technologies, health professionals and those who train them are being challenged to work beyond their traditional comfort zones, often in teams. A new professionalism might be a mechanism for achieving improved health outcomes by applying a transdisciplinary professionalism throughout health care and wellness that emphasizes crossdisciplinary responsibilities and accountability. Establishing Transdisciplinary Professionalism for Improving Health Outcomes discusses how shared understanding can be integrated into education and practice, ethical implications of and barriers to transdisciplinary professionalism, and the impact of an evolving professional context on patients, students, and others working within the health care system.

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