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

Chapter:4 Behaviors of Interprofessional Professionalism

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Suggested Citation:"4 Behaviors of Interprofessional Professionalism." 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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4

Behaviors of Interprofessional Professionalism

Interprofessional professionalism, when practiced by all professions, will improve health care quality and outcome for patients and clients (and I would add their families and caregivers), promote a culture that values and fosters individual competence, and enhance both education and practice environments.

—Jody Frost, Leader of the Interprofessional Professionalism Collaborative

Workshop speaker Frederic Hafferty described an example of the individually focused definitions developed by Herbert Swick in his influential article Toward a Normative Definition of Medical Professionalism, mentioned in Chapter 2 of this report. In his article, Swick identified nine key behaviors of professionalism. The first four (see Box 4-1) focus on individuals.

Forum co-chair Jordan Cohen expressed his agreement with Swick that professionalism as a belief system can be manifested only by behaviors, individual behaviors and institutional behaviors that are the aggregate of individuals. Because institutions do not have behaviors independent of the people who are populating them, the issue is really about individual behaviors that constitute professionalism that can be measured, monitored, improved, taught, and evaluated. The assessment would recognize the personal motivations that influence individuals to behave in the way that is defined by the professions.

Cohen acknowledged that the concept of professionalism is evolving and remains a changing target, but he stressed that, in fact, professionalism is a changing set of behaviors rather than a belief system. In order to

Suggested Citation:"4 Behaviors of Interprofessional Professionalism." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
×

BOX 4-1
Four Behaviors Identified by Herbert Swick

  • Physicians subordinate their own interests to the interests of others.
  • Physicians adhere to high ethical and moral standards.
  • Physicians respond to societal needs, and their behaviors reflect a social contract with the communities served.
  • Physicians evince core humanistic values, including honesty and integrity, caring and compassion, altruism and empathy, respect for others, and trustworthiness.

SOURCE: Hafferty, 2013.

demonstrate proficiency in this area, professionals must adopt behaviors that can be measured and assessed, rather than beliefs.

Hafferty did not disagree with Cohen but took his thinking a step further. Speaking in terms of the medical profession, Hafferty said, an upstream agreement across all disciplines would lay the foundation for discussing behaviors. The agreement would be an announcement to the public about what society can expect from the professions in terms of competencies and ethics. Once the agreement is formed, all the disciplines could then come together through a singular identity for the formation of competency standards and ethical values that would be manifested among trainees. This would eliminate jurisdictional differences among the individual disciplines and form a foundation on which to build a shared language to improve communication among all the health professions.

Such steps toward establishing a shared language among professionals began less than a decade ago by the 14-member group known as the Interprofessional Professionalism Collaborative (IPC) (see Box 4-2). The group’s work was presented by Jody Frost at the workshop. In agreement with the views expressed by Cohen, the IPC is focusing on behaviors that can be assessed.

ASSESSING INTERPROFESSIONAL PROFESSIONALISM BEHAVIORS

According to Frost who leads the IPC, the group’s work involves developing a valid and reliable assessment tool for interprofessional professionalism (IPP) behaviors that can be used by educators across all health professions. It took the group 2 years to develop a shared definition of interprofessional professionalism because each of the 14 representatives had to become comfortable with terms used by the remaining 13 other profes-

Suggested Citation:"4 Behaviors of Interprofessional Professionalism." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
×

BOX 4-2
Members of the Interprofessional Professionalism Collaborative (IPC)

Allopathic Medicine (AAMC)

Audiology (ASHA)

Dentistry (ADEA)

Internal Medicine (ABIM)

National Board of Medical Examiners (NBME)

Nursing (AACN)

Occupational Therapy (AOTA)

Optometry (ASCO)

Osteopathic Medicine (AACOM)

Pharmacy (AACP)

Physical Therapy (APTA)

Psychology (APA)

Speech-Language Pathology (ASHA)

Veterinary Medicine (AAVMC)

sions represented on the IPC. Frost emphasized that the terms used in the definition reflected common meaning and purpose to all the IPC members.

Part of the definition found in Box 4-3 was derived from the work of David Stern (2006) describing common values to all health professions. The concept of multiple health professions working collaboratively or the team-based care with an outcome of optimal health and wellness in individuals and communities is central to the IPC work.

After agreeing on a definition, the group then undertook an iterative process to come up with desirable IPP behaviors within six categories. Table 4-1 shows the six categories and a sample of the 26 observable behaviors identified by the IPC. Frost pointed out that no single profession alone could have developed these IPP behaviors because they are grounded in a team concept rather than specific to any one profession. In building this list of behaviors, the IPC professionals struggled and learned from and with each other, considering behaviors from different perspectives in determining the value of the behavior in terms of worthiness and measurement.

Eight years into its initiation, the IPC is now ready to test the validity and reliability of its assessment tool for IPP behavior. If the instrument is found to be psychometrically sound, the IPC will then disseminate its findings and make the tool widely available without a fee. The IPC’s vision is that the IPP construct will bridge both academic and practice environments because these behaviors should be taught, modeled, and

Suggested Citation:"4 Behaviors of Interprofessional Professionalism." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
×

BOX 4-3
Definition of Interprofessional Professionalism (IPP)

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

SOURCE: Stern, 2006.

TABLE 4-1 Examples of Desirable Interprofessional Professionalism Behaviors

Behavior Description
Communication Communicates with members of other health professions in a way they can understand, without using profession-specific jargon.
Respect Demonstrates confidence, without arrogance, while working with members of other health professions.
Altruism and caring Places patient/client needs above own needs and those of other health professionals.
Excellence Contributes to decisions about patient care regardless of hierarchy/profession-based boundaries.
Ethics Reports or addresses unprofessional and unethical behaviors when working with members of other health professions.
Accountability Accepts consequences for his or her actions without redirecting blame to members of other health professions.

SOURCE: Frost, 2013.

promoted in both academic and practice settings. IPP provides a unique emphasis that underscores communication, collaboration, and negotiation across professional boundaries. This vision highlights professionalism as a resource for promoting skills, values, and organizational structures that facilitate interprofessional care. Likewise, this concept is distinct in focusing on competencies, values, and norms that multiple professions have identified as critical to promoting effective interactions in the provision of patient care.

Suggested Citation:"4 Behaviors of Interprofessional Professionalism." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
×

The ultimate goal of the IPC is to create a resource toolkit to help health professionals and faculties understand the concept of team-based, collaborative professionalism and how these concepts could be applied in educational and practice environments.

ASSESSMENT ON THE CONTINUUM FROM EDUCATION TO PRACTICE

George Thibault from the Josiah Macy Jr. Foundation brought up a question about assessing the health professions’ education to practice continuum and wondered whether the IPC addressed assessment of professionalism within that range. Although Frost found it an intriguing concept, the IPC had not focused on the bridge between interprofessional education and practice. She added, however, that because the IPC is made up of educators, practitioners, and associations, it is well positioned to consider this domain.

Similar to Thibault’s question, Warren Newton from the American Board of Family Medicine asked whether the deliberations of the IPC considered the concept of lifelong learning. More specifically, he asked whether the vision of the IPC moving forward is to incorporate ongoing continuous assessments that are linked to licensure and accreditation. Frost responded that the IPC’s IPP assessment tool measures a moment in time but could be used repeatedly throughout a student’s education. The IPC also considered assessing recent graduates longitudinally on graduation at 10 years, 20 years, and 30 years. In the view of the IPC, health care quality is a continuum that is enhanced as improvements in professionalism occur through role modeling in practice.

INTERPROFESSIONAL PROFESSIONALISM FOR OPTIMAL PATIENT/CLIENT/FAMILY-CENTERED CARE

Professionalism is not an end in itself, but rather it supports the ultimate goals of patient/client/family-centered care, quality, and patient safety, said Frost. Behaviors that demonstrate IPP impact collaborative teamwork and, when coupled with effective communication, contribute to the ultimate goal of high-quality health care, as seen in Figure 4-1. The potential for professionalism to contribute to safe, high-quality, patient/client/family-centered care is intimately connected to the health professionals’ ability to work interprofessionally. Still, Frost believes this connection has not been adequately emphasized in education because of the disciplinary insularity that persists among the health professions. Elucidation of the link between professionalism and care that is provided in a team context by members of different health professions is an urgent priority, she added. Professionalism, combined with cooperation among members of multiple health profes-

Suggested Citation:"4 Behaviors of Interprofessional Professionalism." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
×

image

FIGURE 4-1 Relationship between interprofessional professionalism and quality care.
SOURCE: Frost, 2013. Reprinted with permission from Interprofessional Professionalism Collaborative Members.

sions, is key to achieving patient care goals. Despite its critical importance, cooperation is seldom emphasized within professionalism. In the context of increasing complexity of care, focusing narrowly on professionalism without including cooperation may actually undermine quality and safety by distracting clinicians from the need to collaborate effectively across professions.

Aligned with Frost’s emphasis on the inseparable linkages between collaboration and professionalism, Madeline Schmitt suggested that in the IPC’s figure that demonstrates the relationship between interprofessional professionalism and quality care, professionalism should be the larger circle and interprofessional professionalism the smaller circle. She suggested inverting the two circles so that professionalism is the smaller circle contained within the larger interprofessional professionalism. By reversing them, she said, it forces health professionals to first think collaboratively before considering their individual professions. Figure 4-1 shows IPC’s model with the change suggested by Schmitt.

Shifting attention away from individual behaviors of professionalism to behaviors needed for a shared professionalism creates new conversations as professions begin to recognize shared values. Nevertheless, said Schmitt, along with the shift comes the creation of new tensions. For example, within the ethical behavior domain described in Table 4-1, the health pro-

Suggested Citation:"4 Behaviors of Interprofessional Professionalism." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
×

fessions will need to grapple with differing views of confidentiality and will need to gain a better understanding of how the different health professions relate with patients and their families. In thinking through these issues of professionalism collaboratively, said Schmitt, patients and families become the center of the interprofessional team’s efforts.

REFERENCES

Frost, J. 2013. Interprofessional professionalism: Linking professionalism and interprofessional care. Presented at the IOM workshop Establishing Transdisciplinary Professionalism for Health. Washington, DC, May 14.

Hafferty, F. 2013. Professionalism in education and practice. Presented at the IOM workshop Establishing Transdisciplinary Professionalism for Health. Washington, DC, May 14.

Stern, D. T. 2006. Interprofessional professionalism collaborative: Measuring medical professionalism. Vol. 19. New York: Oxford University Press.

Suggested Citation:"4 Behaviors of Interprofessional Professionalism." 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:"4 Behaviors of Interprofessional Professionalism." 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:"4 Behaviors of Interprofessional Professionalism." 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:"4 Behaviors of Interprofessional Professionalism." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
×
Page37
Suggested Citation:"4 Behaviors of Interprofessional Professionalism." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
×
Page38
Suggested Citation:"4 Behaviors of Interprofessional Professionalism." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
×
Page39
Suggested Citation:"4 Behaviors of Interprofessional Professionalism." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
×
Page40
Suggested Citation:"4 Behaviors of Interprofessional Professionalism." Institute of Medicine. 2014. Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18398.
×
Page41
Suggested Citation:"4 Behaviors of Interprofessional Professionalism." 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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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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