Greater professionalism could be the key to better hospital care

(BPT) – Healthcare reform has been in the headlines for years, and it seems like the only point everyone agrees on is that something needs to be done to improve the system. While politicians debate who should pay for healthcare and how, a group of healthcare professionals, patients and community advocates have set forth new guidelines to help healthcare organizations take better care of patients and communities. At the heart of their proposal is the idea of improving professionalism in healthcare organizations.

Funded by the Commonwealth Fund, the ABIM Foundation, The American Hospital Association, the Federation of American Hospitals, and Northwell Health, and published in the Jan. 11 issue of Academic Medicine, the “Charter on Professionalism for Healthcare Organizations” aims to encourage hospitals and healthcare organizations to radically change the way they operate. The authors acknowledge that the kind of sweeping changes they advocate won’t be easy. No single healthcare organization can fully embody all of the described behaviors. Rather the Charter is aspirational.

“Transitioning to the model hospital described by the Charter will challenge historical roles and assumptions of both leadership and staff,” the authors write. Still, they say, making these changes can benefit patients, healthcare providers and organizations.

The emphasis on professionalism

In the Academic Medicine article, the authors acknowledge that both health care professionals and patients are caught up in a vast, difficult, rapidly changing and ethically challenging system. Professionalism can help providers and organizations with decision-making in such a fluid and challenging system, they say. “Professionalism is based on a specific set of principles and commitments that provide an orientation to the thoughts and actions of a given profession,” the authors write.

In 2002, a physician charter was published, establishing professionalism ideals for doctors. While physicians largely embraced the charter, they also reported that policies and organizational structures of the healthcare organizations they worked for and with were standing in the way of fully implementing the guidelines. Incorporating professionalism guidelines into organizational structures could help foster more professional, successful and patient-centric care for everyone, the authors say.

Five key areas of focus

The charter outlines five areas of focus for healthcare organizations:

* Greater involvement and partnership between healthcare organizations and the patients they serve.

*Stronger partnerships between healthcare organizations and the communities in which they are located.

* Greater attention to the well-being of healthcare workers to help reduce burnout, and make them better equipped to provide superior care for patients.

* More collaboration between hospitals, government and community groups to positively affect the social factors that determine health.

* Greater emphasis on ethical business practices that will improve patients’ access to care, quality of care and hospitals’ financial performance.

Realigning priorities to patients

Movement toward more ethical business practices may require the greatest shift in thinking, the authors admit. While the essential objective of healthcare should be to take care of people, the reality is “opportunities (exist) for healthcare providers and organizations to engage in activities that are not in concordance with the principles of medical professionalism,” the Charter authors note.

The Charter advocates that when a healthcare organization faces a choice between actions that benefit the organization or those that benefit the patient, the patient’s interests should be the priority.

“When ethical dilemmas arise from conflicts between an organization’s self-interest and those of the community or patient, the community or patient interest takes precedence,” the authors write. “While this premise of the Charter may seem controversial, it is central to its content, consistent with the seminal Physician Charter on Medical Professionalism, and the source of its greatest potential social benefit.”

Hospitals and healthcare organizations should take patient-centric steps to:

* Protect patient privacy and health information, especially when using electronic health records.

* Establish systems to identify and address conflicts of interest and, when they affect a patient, put the patient’s welfare before that of the organization.

* Be transparent about the cost of procedures and care.

* Make bill adjustments for uninsured patients so that they don’t have to pay substantially more than those with insurance.

* Fairly grant “charity status” to patients who can’t pay for treatment.

* Be flexible in settling patient balances that exceed a patient’s ability to pay.

To review the full Charter, visit the website of the Foundation for Medical Excellence at

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