Measuring professionalism in medicine and nursing: results of a European survey.
BACKGROUND
Leveraging professionalism has been put forward as a strategy to drive improvement of patient care. We investigate professionalism as a factor influencing the uptake of quality improvement activities by physicians and nurses working in European hospitals.


OBJECTIVE
To (i) investigate the reliability and validity of data yielded by using the self-developed professionalism measurement tool for physicians and nurses, (ii) describe their levels of professionalism displayed, and (iii) quantify the extent to which professional attitudes would predict professional behaviors.


METHODS
We designed and deployed survey instruments amongst 5920 physicians and nurses working in European hospitals. This was conducted under the cross-sectional multilevel study "Deepening Our Understanding of Quality Improvement in Europe" (DUQuE). We used psychometric and generalized linear mixed modelling techniques to address the aforementioned objectives.


RESULTS
In all, 2067 (response rate 69.8%) physicians and 2805 nurses (94.8%) representing 74 hospitals in 7 European countries participated. The professionalism instrument revealed five subscales of professional attitude and one scale for professional behaviour with moderate to high internal consistency and reliability. Physicians and nurses display equally high professional attitude sum scores (11.8 and 11.9 respectively out of 16) but seem to have different perceptions towards separate professionalism aspects. Lastly, professionals displaying higher levels of professional attitudes were more involved in quality improvement actions (physicians: b = 0.019, P<0.0001; nurses: b = 0.016, P<0.0001) and more inclined to report colleagues' underperformance (physicians--odds ratio (OR) 1.12, 95% CI 1.01-1.24; nurses - OR 1.11, 95% CI 1.01-1.23) or medical errors (physicians--OR 1.14, 95% CI 1.01-1.23; nurses - OR 1.43, 95% CI 1.22-1.67). Involvement in QI actions was found to increase the odds of reporting incompetence or medical errors.


CONCLUSIONS
A tool that reliably and validly measures European physicians' and nurses' commitment to professionalism is now available. Collectively leveraging professionalism as a quality improvement strategy may be beneficial to patient care quality.
Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Kiki M J M H
KM
Lombarts
Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Thomas
T
Plochg
Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America; Palo Alto Medical Foundation Research Institute, Palo Alto, California, United States of America.
Caroline A
CA
Thompson
Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America; UCLA Center for Health Policy Research, Los Angeles, California, United States of America.
Onyebuchi A
OA
Arah
D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003625:Data Collection; D005060:Europe; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009726:Nurses / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D058996:Quality Improvement; D012107:Research Design