The President and Professionalism
It started in the winter of 1998 with a handful of UTMB employees sitting around a table with the university's new president, Dr. John Stobo. He wanted to create a professionalism task force and they would become its first members.
Soon after Stobo arrived on UTMB's campus in late 1997, the institution-like many other academic health centers in the nation-faced a financial crisis. Employee morale was down, but Stobo was optimistic about UTMB. He also felt strongly that a culture of professionalism, that of putting the needs and interests of others first, needed to be an institutional priority. He also felt that professionalism needed to be not a desired state, but rather an expected one at UTMB. The professionalism task force would help accomplish this.
Stobo's work around professionalism actually started back in 1992, when he received a call from the American Board of Internal Medicine (ABIM). His caller asked if he would chair a subcommittee being formed on Project Professionalism , aimed at helping to raise awareness among internal medicine practitioners about professionalism. He agreed. Stobo admits he was skeptical the project would have much impact, but he felt that focusing on professionalism was of vital importance to a profession being buffeted by a turbulent medical climate defined by a rising emphasis on reimbursement and a growing focus on seeing more patients while spending less time with each one.
At the time, Stobo was the William Osler Professor of Medicine and chair of the Department of Medicine at Johns Hopkins University School of Medicine. In 1994, the subcommittee rolled out a working definition of professionalism and a workbook for residency training program directors and faculty to use in teaching and evaluating professionalism. The materials were embraced by the internal medicine community, as well as other medical subspecialty organizations. A variety of ABIM professionalism projects grew out of Project Professionalism , including the medical professionalism project UTMB participates in today.
Fast forward to Dr. Stobo's first months at UTMB. One of the first things he did upon becoming president was to hold a "Town Meeting" in the main campus auditorium, which more than one thousand people attended. The new president shared what he'd been hearing around campus and talked about what he felt the institution's values were. Then he asked for feedback. He received plenty. He got some push-back, too; but after months of discussion and debate, the university outlined its core values and mission, laying the foundation for the work the professionalism task force would accomplish in the coming months.
Over the ensuing months and years, a series of incremental successes in raising awareness and accountability around professionalism eventually evolved into a changing culture at UTMB.
One of the first communication strategies was the professionalism brochure, which recognized faculty, staff, and students who exemplified professional behavior. A popular peer recognition program called Going the Extra Mile (or GEM) was instituted in 2000 to encourage employees to recognize others for exemplary performance. A program instituted later that year rewards hourly employees for their commitment to professionalism by conserving their sick leave.
Other professionalism-related programs instituted under Stobo's leadership include the leadership development curriculum, which was recognized in the 2002 American Hospital Association's Commission on Workforce for Hospitals and Health Systems best practices report, In Our Hands: How Hospital Leaders Can Build a Thriving Workforce . UTMB also holds an annual support staff conference designed to improve the skills and professionalism of all administrative support associates.
Two years ago, a group of students approached the president about creating a unifying statement on professionalism that could be adopted throughout the institution. To accomplish the task, an Honor Pledge Committee was formed, comprising students from each of UTMB's four schools. Debuted in January of this year, the honor pledge re-energized the entire institution's commitment to a culture of professionalism.
Another recent development came in November 2002, when the ABIM Foundation announced that UTMB had been selected to participate in a medical professionalism pilot project called Putting the Charter into Practice . Aimed at applying the principles and responsibilities found in the ABIM's landmark International Charter on Medical Professionalism to medical students, UTMB eagerly embraced the challenge. While the other four participating schools applied the charter solely to their medical schools, Stobo decided UTMB would apply the charter to all four of its schools. He then went one step further, applying the charter to the entire institution.
Over the past few months, a Professionalism Charter Subcommittee (consisting of student, administrative, and clinical representatives from across the institution), has been working to turn this into reality, meeting weekly and combing through the dense language of the physician charter to make it applicable to everyone at UTMB.
The subcommittee's work is paying off. In addition to transforming the ABIM's original physician charter into a version unique to UTMB, the group has started cataloguing where within each school's curriculum professionalism is taught so that gaps can be identified and effective teaching replicated. In addition, the group is working to ensure that professionalism is a standard component in all performance evaluations for faculty, staff, and students. In the UTMB medical residency program, evaluating professionalism became standard practice in July 2003, and numerous other activities will keep the institution busy for years to come.
"With this project," says Kathy Shingleton, head of UTMB's Human Resources Department, "we're relighting the fire, re-engaging, reminding, refreshing, and taking professionalism to the next level. Everybody knows we're going to measure it. They know it's going to be in everything they see, so now it's really here to stay."