professionalism in health care - aapm...

Professionalism in Health Care William Hendee, PhD

PROFESSIONALISM

• Accountability

• Ethics

• Leadership

© WRH (Sept., 2012)

PROFESSIONALISM

• Placing the interests of others ahead of one’s personal interests

• First step to being a professional – decide you are one

© WRH (Sept., 2012)

ELEMENTS OF PROFESSIONALISM

IN HEALTH CARE

• Altruism

• Excellence

• Humanism

• Duty

• Accountability

• Honesty/Integrity

• Respect for Others

© WRH (Sept., 2012)

HOW IS PROFESSIONALISM JUDGED?

• Competence

• Communication

• Appearance

• Demeanor

© WRH (Sept., 2012)

FOUR T’S OF PROFESSIONALISM

• Truth

• Trust

• Teamwork

• Training

© WRH (Sept., 2012)

SOME DON’TS OF PROFESSIONALS

• Overstepping boundaries

• Involvement in others’ affairs

• Gossip

• Personal activities at work

• Breaching confidentiality

• Bringing emotional baggage

to work

• Criticizing superiors

• Inappropriate language

© WRH (Sept., 2012)

CHALLENGES TO MEDICINE’S

PROFESSIONAL STATURE • Rising healthcare costs

• Lack of overarching health coverage

• Large geographic variations in health care

• Need for evidence-based health care

• Time constraints on healthcare providers

• Safety of health care

• Conflicts of interest

© WRH (Sept., 2012)

PRINCIPLES OF THE PHYSICIAN CHARTER

• Primacy of patient welfare

• Patient autonomy

• Social justice

© WRH (Sept., 2012)

PHYSICIAN’S CHARTER RESPONSIBILITIES

(ABIMf, ACP/ASIMf,EFIM) • Competence

• Confidentiality

• Quality of Care

• Just Distribution Resources

• Manage CoI

• Honesty

• Appropriate Relations

• Access to Care

• Scientific Knowledge

• Professional Responsibilities

© WRH (Sept., 2012)

ACGME CORE COMPETENCIES

• Patient Care

• Medical Knowledge

• Practice-Based Learning/Improvement

• Interpersonal/Communication Skills

• Professionalism

• Systems-Based Practice

© WRH (Sept., 2012)

ELEMENTS OF A PROFESSION

• Formal education

• Control over educational standards

• Self-regulation/disciplinary standards

• Scholarly journal

• Relatively high social status

• Protection from state regulation/market pressures

KR Sethuraman

Regional Health Forum (2006) 10

© WRH (Sept., 2012)

ELEMENTS OF PROFESSIONALISM

IN SCIENCE • Intellectual Honesty

• Excellence in Thinking and Doing

• Collegiality and Openness

• Autonomy and Responsibility

• Self Regulation

S. Korenman

Univ of California 2006

© WRH (Sept., 2012)

EXPANSION OF THE ELEMENTS OF

PROFESSIONALISM IN SCIENCE

1. Honesty and fairness in proposing, performing, and reporting research;

2. Accuracy and fairness in representing contributions to research proposals and reports;

3. Proficiency and fairness in peer review;

4. Collegiality in scientific interactions, communications and sharing of resources;

© WRH (Sept., 2012)

EXPANSION OF THE ELEMENTS

5. Disclosure of conflicts of interest;

6. Protection of human subjects in research;

7. Humane care of animals in research;

8. Adherence to the mutual responsibilities of mentors and students.

© WRH (Sept., 2012)

TEN ATTRIBUTES OF LEADERSHIP

Vision Integrity

Dedication Magnanimity

Humility Openness

Creativity Fairness

Assertiveness Sense of Humor

© WRH (Sept., 2012)

“Good business leaders create a vision, articulate the vision, passionately own the vision and relentlessly drive it to completion.”

Jack Welch

Former Chair and CEO

General Electric Co.

© WRH (Sept., 2012)

People buy into the leader before they buy into the vision.

John Maxwell

© WRH (Sept., 2012)

A LEADER HAS

Solidarity Modesty

Self-confidence Initiative

Creativity Passion

Symbolic Value

http://life.halcode.com/archives/2008/04/13/the-7-attributes-of-leadership/

© WRH (Sept., 2012)











INNER HABITS, QUALITIES AND TRAITS

OF TRUE LEADERS • Enthusiasm

• Integrity

• Self-confidence and self-reliance

• Persistence and determination in challenging situations

• Positive mental attitude

• Willingness to change and consider new opportunities

• Creativity in searching for new solutions

• Personal charisma

• Empathy towards others

• Faithfulness and fairness

© WRH (Sept., 2012)

9 RULES OF A TEAM LEADER

1. Provide purpose

2. Build a star team, not a team of stars

3. Establish shared ownership for the results

4. Develop team members to fullest potential

5. Make the work interesting and engaging

6. Develop a self-managing team

7. Motivate and inspire team members

8. Lead and facilitate constructive communication

9. Monitor, but don’t micromanage

© Vadim Kotelnikow

© WRH (Sept., 2012)

FAILURE IN LEADERSHIP

12 MAJOR CAUSES 1. Inability to organize detail 2. Unwillingness to do what they would ask another to do 3. Expectation of pay for what they know instead of what they

do 4. Fear of competition from others 5. Lack of creative thinking in setting goals and creating plans 6. The “I” syndrome 7. Over-indulgence, destroying endurance and vitality 8. Disloyalty to colleagues 9. Leading by instilling fear instead of encouraging 10. Emphasis of title instead of knowledge and expertise 11. Failure to face the negative reality 12. Being ultra-positive

Adapted from Motivate to Win, Richard Denny © WRH (Sept., 2012)

DIFFERENCES IN MANAGERS

AND LEADERS MANAGERS LEADERS

Administer Innovate

Ask how and when Ask what and why

Focus on systems Focus on people

Do things right Do the right things

Maintain Develop

© WRH (Sept., 2012)

DIFFERENCES IN MANAGERS

AND LEADERS MANAGERS LEADERS

Rely on control Instill trust

Short-term perspective Long-term perspective

Accept status quo Challenge status quo

Focus on bottom line Focus on horizon

Emulate classic good soldier Are their own persons

© WRH (Sept., 2012)

The Leader is best,

When people are hardly aware of his existence,

Not so good when people praise his government,

Less good when people stand in fear,

Worst, when people are contemptuous.

Fail to honor people, and they will fail to honor you.

But of a good leader, who speaks little

When his work is done, his aim fulfilled,

The people say, 'We did it ourselves.

Lao Tzu

~500 BC

© WRH (Sept., 2012)

DEFINITIONS

• ETHICS – Rules for acceptable behavior expected by Society

• MORALS – Rules for acceptable behavior expected by a Religious Order

© WRH (Sept., 2012)

ETHICS IN HEALTH CARE

• Biomedical Ethics: rights of patients and the public

• Professional Ethics: integrity and virtues of professionals

• Organizational Ethics: business/management of organizations

© WRH (Sept., 2012)

ETHICS REFERENCE

Hendee, W.R., Bosma, J.L, Bresolin, L.B., Berlin, L, Bryan, R.N., Gunderman, R.B., Web modules on professionalism and ethics, J Am Coll Radiol, 9: 170-173, 2012.

http://www.aapm.org/education/onlinemodules.asp

© WRH (Sept., 2012)

MODULE: ATTRIBUTES OF

PROFESSIONS/PROFESSIONALS Competence Honesty

Confidentiality Appropriate Relationships

Quality of Care Access to Care

Just Distribution Resources Scientific Knowledge

Manage COI Professional Responsibilities

© WRH (Sept., 2012)

MODULE: HUMAN SUBJECTS RESEARCH

BELMONT REPORT’S THREE ETHICAL CONCEPTS

• Respect for persons, requiring informed consent

• Justice, requiring equitable distribution of burdens and benefits

• Beneficence, requiring risks balanced by value of knowledge generated

© WRH (Sept., 2012)

THREE IDEAS TO IMPROVE 1991

COMMON RULE REGULATIONS

Make Informed consent truly informed

Compensate for Subject harms

Peer review Human studies

Rebecca Dresser

Science 337 August 3, 2012

© WRH (Sept., 2012)

MODULE: GRADUATE AND RESIDENT

EDUCATION • Responsible Teachers

• Responsible Students

• Responsible Research Mentoring

• Need for Professional Mentoring

• Recall Question Issue

© WRH (Sept., 2012)

ISSUES OF RESEARCH MENTORING

• Whose needs come first – mentor or student?

• Should a student have a research mentor and a professional mentor?

• How to instill leadership/professionalism/ethics

• What are the responsibilities of mentors towards students?

• What are the responsibilities of students towards mentors?

© WRH (Sept., 2012)

MODULE: RESEARCH

ETHICS/MISCONDUCT

Fabrication Falsification

Plagiarism Record-Keeping

Ownership Transparency

© WRH (Sept., 2012)

RESEARCH MISCONDUCT

CHARACTER TRAITS • The Desperate – fear of failure

• The Perfectionist – failure is a catastrophe

• The Ethically Challenged – succumb to temptation

• The Grandiose – judgment doesn’t require verification

• The Sociopath – without conscience

D. Kornfeld, Wing of Zock

August 2012

© WRH (Sept., 2012)

MODULE: PERSONAL BEHAVIOR,

EMPLOYEE-EMPLOYER RELATIONS Teamwork/Demeanor Respect/Concern for Others

Accountability/Initiative Responsibility/Sense of Duty

Scholarship Commitment to Learning

Integrity Trustworthiness

© WRH (Sept., 2012)

MODULE: PROFESSIONAL/PATIENT

RELATIONS Altruism Excellence

Humanism Duty

Accountability Honesty

Integrity Respect for Others

© WRH (Sept., 2012)

MODULE: PUBLICATION

Authorship Use of Other’s Work

Redundancy Acknowledge Others

Transparency Clarity

© WRH (Sept., 2012)

CHALLENGES TO COLLEGIALITY AND

SHARING IN SCIENCE • Materials Transfer Agreements

• Patenting and Licensure

• Indemnification

• Industry/Academic Cooperative Agreements

• Publication Review

• Recognition of Others (Literature, Research Group)

© WRH (Sept., 2012)

MODULE: VENDOR RELATIONS

Independence Accountability

Publication Indemnification

Testimonials COI

© WRH (Sept., 2012)

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