Professionalism: a necessary ingredient in a culture of safety.

Background: A safety culture requires the highest levels of professionalism. A Code of Professionalism was created in an obstetrics service line as a mechanism to address unprofessional behavior. In this initiative, a multidisciplinary Code of Professionalism was established, with the support of leadership and the employee and nursing unions, to help create a safety culture.

Methods: In 2005 the Code of Professionalism was introduced to physicians, nurses, and support staff. The U.S. Agency for Healthcare Research and Quality (AHRQ) Patient Safety Culture Survey was used, along with a portion of the Institute for Safe Medication Practices (ISMP) Survey on Workplace Intimidation to measure changes in the safety culture. Data were collected in 2005, 2008, and 2011.

Results: One hundred thirty-four reports were made to the committee on professionalism between February 2005 and December 2010. Some 96 (72%) of the reports were submitted by nurses, with physicians accounting for 13%. Seventy-five of the reports (56%) were about unprofessional behavior by physicians and 46 (34%) were about unprofessional nursing behavior. On the AHRQ Patient Safety Culture Survey, statistically significant improvement was shown in the Teamwork Within Units dimension, from 2005 to 2008; the Management Support dimension, from 2005 to 2008; the Organizational Learning dimension, from 2005 to 2008 and also from 2008 to 2011; and the Frequency of Events Reported dimension, from 2008 to 2011.

Discussion: Implementing a multidisciplinary Code of Professionalism can improve the safety culture in a hospital. When leadership sets clear standards and holds physicians and staff to the same standard, improvements in an organization's safety culture can serve as the foundation for the delivery of safer care.