Lombarts Kiki M J M H, Plochg Thomas, Thompson Caroline A, Arah Onyebuchi A
Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
PLoS One. 2014 May 21;9(5):e97069. doi: 10.1371/journal.pone.0097069. eCollection 2014.
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.
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.
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.
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.
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.
发挥专业精神已被提出作为推动改善患者护理的一项策略。我们研究专业精神作为影响欧洲医院医生和护士开展质量改进活动的一个因素。
（i）调查使用自行开发的医生和护士专业精神测量工具所产生数据的可靠性和有效性，（ii）描述他们所展现的专业精神水平，以及（iii）量化专业态度对专业行为的预测程度。
我们在欧洲医院工作的5920名医生和护士中设计并部署了调查问卷。这是在横断面多层次研究“深化我们对欧洲质量改进的理解”（DUQuE）中进行的。我们使用心理测量和广义线性混合建模技术来实现上述目标。
共有来自7个欧洲国家74家医院的2067名医生（回复率69.8%）和2805名护士（94.8%）参与。专业精神工具显示了专业态度的五个子量表和一个专业行为量表，具有中等至高的内部一致性和可靠性。医生和护士的专业态度总分同样高（满分16分，分别为11.8分和11.9分），但对不同的专业精神方面似乎有不同的看法。最后，展现出更高水平专业态度的专业人员更多地参与质量改进行动（医生：b = 0.019，P < 0.0001；护士：b = 0.016，P < 0.0001），并且更倾向于报告同事的工作表现不佳（医生——优势比（OR）1.12，95%置信区间1.01 - 1.24；护士——OR 1.11，95%置信区间1.01 - 1.23）或医疗差错（医生——OR 1.14，95%置信区间1.01 - 1.23；护士——OR 1.43，95%置信区间1.22 - 1.67）。参与质量改进行动被发现会增加报告不称职或医疗差错的几率。
现在有了一种可靠且有效的工具来衡量欧洲医生和护士对专业精神的践行。将专业精神作为一种质量改进策略加以集体利用可能有利于患者护理质量。
