In my estimation, professionalism has a lot to do with personal values. Thus, when individuals or clinicians are aggregated into groups, their personal values form the base of their organization’s values and culture.
It’s not surprising to this sociological-thinking individual when studies show that the differentiating factors between low- and high–performing institutional and ambulatory clinical practices are an organization’s values, its culture and those who promote its values (i.e., its leaders).
Leslie Curry et al. recently examined this influence of culture in What Distinguishes Top-Performing Hospital in Acute in Acute Myocardial Infraction Morality Rates? from the Annals of Internal Medicine. The qualitative study looks at high- and low-performing hospitals in risk-standardized mortality rates for AMI cases. They found that improved technical processes and protocols do not produce the differences in performance for care for patients with AMI. The determining factors for high-performing hospitals were:
- Differences in organizational values and goals
- Senior management involvement
- Communication and coordination among the team members and
- Group problems solving and learning.
Low-performing hospitals did not have a shared vision of excellence. There was sporadic involvement of senior management and lack of respect for members of the team and diversity of roles. These clinicians failed to work with others on a team, strive for excellence or coordinate care with other physicians. They did not fulfill the 21st century version of the medical professionalism. I’d probably look for care somewhere else.
Other studies have come to a similar conclusion, such as Lanham et al.’s How Improving Practice Relationships Among Clinicians and Non-Clinicians Can Improve Quality in Primary Care. This meta-analysis of high-performing practices determined that relationships among team members and communication were the determining factors of high-performing practices. It seems that quality of care is a trait that emerges from conversations among team members.
So why do we spend so little time on building conversation among clinicians about their values, mutual respect of clinicians and communication skills? Why do structure and systems of health care delivery trump the importance of culture, values and relationships when multiple studies point to the opposite conclusion?
What do culture and professionalism have to do with it? Recent studies say, a lot.
Daniel Wolfson is COO of the ABIM Foundation and blogs at The Medical Professionalism Blog.
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