Professionalism

Incident Processing

Professionalism Concern Process (September 2017)

  1.  The reporter submits a concern via the professionalism “button”.
  2. The concern is received and acknowledged by a professionalism triage officer by electronic interface through the MedSIS platform.
  3. If the concern is anonymous (where the reporter does not submit their name and contact information via the “button”), the concern is logged and discussed at the next professionalism triage committee. Note:  if there are future named reported concerns, prior anonymous reports are referred to without details in the outgoing letters to the faculty officer or supervisor overseeing the subject of the concern (ie:  Divisional Director, Department Chair, AHS Site Lead, Supervisor, Undergraduate/Postgraduate Deans, Program Director).If there are three or more anonymous concerns regarding the same situation/behavior in a group setting (ie:  inappropriate comments made by a lecturer to a class), a letter summarizing the anonymous concerns are sent to the faculty officer overseeing the individual.
  4. If the concern is named (where the reporter submits name and contact information via the “button”), the triage officer contacts the reporter of the concern via email (within 3 working days).
  5. If the concern is felt to be egregious, or urgent (ie:  patient or learner safety is at risk), the triage officer contacts the Associate Dean, Professionalism, immediately, to discuss immediate management of the concern, and possible escalation of intervention.
  6. If the concern does not require immediate intervention, the triage officer extends an email invitation to meet or speak to the reporter in person or by phone. This meeting is confidential, to gather more information around the situation, the reporter’s perspective and goals around the report.
  7. A confidential meeting and/or phone call between the triage officer and the reporter occurs.
  8. If the reporter agrees, a confidential letter containing a verbatim copy of the concern report is sent to the subject’s faculty officer or supervisor from the Office of Professionalism.  On occasion, the triage officer may redirect the concern report to other avenues if appropriate (ie:  quality care rounds, human resources, Alberta Health Services).
  9. The subject’s faculty officer or supervisor acknowledges receipt of the letter to the Office of Professionalism and follows the FoMD faculty officer expectations on receiving a letter of concern, confidentially investigating the report, utilizing the FoMD professionalism concern classification and interventions.
  10. The subject’s faculty officer or supervisor communicates with the Office of Professionalism re:  outcome of investigation and mutually agreed-upon course of action.
  11. The Professionalism Triage Committee reviews submitted concerns, ongoing investigations and outcomes every 6 weeks, closing concluded concerns by consensus. There is a goal timeline of 6 months for submission of concern to concern report review and closure.
  12. Records of concerns are retained in the same fashion and for the same time period, as for all Human Resource Records at the University of Alberta. 

Classification of FoMD Professionalism Concerns:

1. A Miscommunication/Misunderstanding 
2. An “Oops” Incident
- The individual knows the rules, and does generally follow them. On a rare occasion, he or she has a lapse and does not meet role expectations.
- insight is demonstrated, the person recognizes their error and is remorseful.
3. A “Can’t” Incident
- The individual can’t fill role expectations because he or she does not know the rules of the role, or may not have the skills to enact them. The person may be new to the culture, or does not understand the rules of the workplace. There may or may not be insight.
4. A “Won’t” Incident:  
- the individual knows the rules of the role, and has the skills to enact them, chooses not to act according to those expectations. The person named in the report holds the perspective that rules of the workplace don’t apply to him or her, or that the workplace rules are “wrong”. There is lack of regret, insight or remorse. This may be indicative of “disruptive behaviour” in the workplace.

Note:   if there are repeated “miscommunication/misunderstandings”, “oops” incidents, or “can’t” incidents, this may be indicative of underlying professionalism difficulties and/or wellness difficulties, and may require further intervention/remediation.  

FoMD Professionalism Concern Intervention:*
1. Informal conversations for single incidents (“cup of coffee” conversations)
2. Nonpunitive “awareness” interventions – patterns of events/behaviour
3. Leader-developed action plans – if patterns persist, remediation (department/program level)
4. Imposition of disciplinary processes – failure of plans, immediate concern for harm to others (University of Alberta, College of Physicians and Surgeons of Alberta, Alberta Health Services, Alberta Dentist Association, College of Medical Laboratory Technologists of Alberta, Alberta College of Medical Diagnostic and Therapeutic Technologists, College of Registered Dental Hygienists of Alberta).

 *Derived from Vanderbilt Graduated Intervention (Hickson et al, Acad Med 2007) & Health Quality Council of Alberta Guidelines 

Definition of “egregious” professionalism concern**:

  • Any one of:
    • Multiple previous professionalism concerns raised or did not successfully remediate previous concerns of professionalism (x 2 remediations/leader developed action plans) and/or
    • Egregious, or potential for egregious, harm to others (faculty, learners, patients, public or institutions) and/or
    • Behaviour inconsistent with a future career in medicine
  • This may include but is not restricted to:
    • Harassment (sexual, racial)
    • Discrimination
  •  “Won’t” professionalism behaviour as per above classification and/or (iv) failure of remediation/leader-developed action plans
  • Level 3 or 4 disruptive behaviour (Health Quality Council of Alberta)***

 ** Student Professionalism Policy, Undergraduate Medical Education, Queen’s University

*** Health Quality Council of Alberta Disruptive Behaviour Framework (Provincial Framework, March 2013)