Barbara van der Schalie, MA
Senior Clinical Research Training Manager
Clinical Monitoring Research Program Directorate
Frederick National Laboratory for Cancer Research
Abstract: Professionalism is a key component of a dynamic, thriving workplace and a defining element of a productive workplace culture. As clinical research becomes more generationally diverse, professionalism standards are becoming less consistent. This article describes the changing concepts of professionalism, how it is judged, and how to optimize professionalism to benefit individuals and organizations.
Disclaimer: This project has been funded in whole or in part with federal funds from the National Institutes of Health’s National Cancer Institute, under Contract No. 75N91019D00024. The content of this article does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of tradenames, commercial products, or organizations imply endorsement by the U.S. government
Introduction to Professionalism
Research on professionalism will help staff who are managing clinical research programs make decisions about the professionalism program in their workplaces. As David Maister, author of “Trusted Advisor” said, “Professionalism is not a label you give yourself. It’s a description you hope others will apply to you.” This article focuses not only on how clinical research professionals behave, but also on how others perceive their skills and behaviors, and how those factor into professional conduct.
Webster’s dictionary defines professionalism as “The conduct, aims, or qualities that characterize or mark a profession or professional person.” Professionalism applies to occupations requiring specialized knowledge and often long and intensive academic preparation. A professional conforms to the technical, ethical, and/or behavioral standards of a profession.
In the past, a professional was someone who received money for providing a specific service. For example, there was a time when professional athletes could not compete in the Olympics because they were being paid to provide that service elsewhere. Clinical research professionals are also paid for providing a specific service.
Extensive research has been conducted on professionalism, including the Center for Professional Excellence Survey, which began in 2009. The Center for Professional Excellence, located at York College, wanted to learn how to prepare its students to be professionals in the workplace. The last data from the survey were available in 2015. Table 1 highlights the survey results.
Certain characteristics of professionalism were routinely ranked near the top in the survey:
- Punctuality/attendance
- Strong communication skills
- Appearance
- Interpersonal skills
Punctuality/attendance and appearance are professional behaviors, while strong communication skills and interpersonal skills are skills and knowledge. Thus, the characteristics of professionalism employers noted were a blend of professional behaviors and skills and knowledge.
Through 2013, communication skills were the top ranked characteristic. In 2014, being prepared to do the job, which covers behaviors and skills, was the top ranked characteristic. By 2015, the top ranked characteristic was being focused on the job, which means being able to execute the job from beginning to end without becoming distracted.
The survey also asked about unprofessional behaviors. Through 2013, a poor work ethic (apathy and
being unfocused), entitlement, and appearance were the top ranked unprofessional behaviors. Entitlement is the expectation for recognition and promotions because of who someone is rather than what they do. Inappropriate appearance for a job was also a top ranked unprofessional behavior.
In 2014 and 2015, the top ranked unprofessional behaviors were:
- Disrespect
- Lack of ambition
- Entitlement
- Appearance
- Lack of communication skills
- Using a cell phone or texting inappropriately or at inappropriate times
Disrespect was the most highly recognized unprofessional behavior in both years. Of the characteristics of unprofessional behaviors, people had the most diverse perceptions about being disrespectful.
Evaluating Professionalism
In the workplace, professionalism is evaluated against expectations or standards (Table 2). The evaluation of professionalism is situational in nature. Different workplaces might have different standards for professionalism, and these standards could even differ according to the situation. For example, the COVID-19 pandemic and the remote or hybrid work culture has had a strong impact on professional expectations.
Professionalism is strongly influenced by culture. Workplaces such as Apple and Google have different professionalism standards than a government or health care environment.
There are common parameters for evaluating professionalism for both individuals and groups. Professionalism is a grassroots effort; it starts with individuals and rolls up to the group level. Different groups may be evaluated on professionalism, and people’s perspectives on the professionalism of a group might specifically be based on the level of professionalism of the individuals in the group. For this reason, common parameters for evaluating professionalism are communication, punctuality, competence, and demeanor.
How to Establish a Workplace-Specific Culture of Professionalism
Establishing a workplace-specific culture of professionalism is a three-phase process:
- Establish the need for a professionalism standard and provide an informational overview
- Determine the professional behaviors to be encouraged
- Determine monitoring and metrics and provide support to participants
The Need for a Professionalism Standard
Establishing the need for a professionalism standard and providing an informational overview is the first phase of establishing a workplace-specific culture of professionalism (Table 3), and a great deal of research has been conducted on this topic. It is important to characterize the target audience. This involves determining exactly who will be involved in the initiative, whether participation is voluntary, and whether everyone in the organization will be held to the same professionalism standards. Once the audience has been characterized, it is necessary to communicate the value of the professionalism standard to the target audience and to their leadership and management.
For any professionalism standard, buy-in is necessary, so it is important to establish the need for a professionalism standard. To obtain buy in, it is necessary to do extensive research on the specific workplace. A great deal of research on health care professionalism is available specifically about doctors and nurses. Research on the specific workplace should focus on current workplace challenges; any global standards; gender, generational, and ethnic diversity; and the way in which the professionalism standard must address diversity in the workplace.
Once appropriate research has been done, determine which factors influence professionalism in the specific workplace. This determination should consider both the importance of the behaviors and skills and the urgency of each factor. Importance does not change. Professionalism standards are based on foundationally important behaviors. Urgency, however, is based on the needs of the workplace. It is also important to analyze why it is necessary to establish professionalism standards currently.
Professional Behaviors to be Encourgaed
Once buy-in for establishing the professionalism standards is obtained, the second phase of establishing a workplace-specific culture of professionalism is determining the professional behaviors to be encouraged in the specific workplace (Table 4). This starts with collecting input and providing examples. Staff should also request suggestions. They may conduct a survey to select behaviors, ethical standards, and skills/knowledge to be encouraged, or they may conduct focus groups. Finally, staff communicate the survey results.
Thus, the second phase of establishing a workplace-specific culture of professionalism is based on research and the buy-in that has already been established. Buy-in is necessary to ensure people take the survey and then buy into the behaviors and skills that become part of the professionalism standards.
Many behaviors and skills are generally important to professionals in the workplace, whether physical, virtual, or hybrid. Some of these behaviors and skills may or may not be important for a specific workplace. Behaviors include:
- Exhibiting mature responsibility and showing passion for their work
- Having personal respect and respect for others and their time
- Coming to work with a good attitude and performing well
- Being friendly and a team player
- Showing a willingness to learn and volunteer for new tasks
- Being accountable for what they say and do, and what they leave undone
- Being a good role model for others including their behavior, attitude, and relationships
- Working well under pressure
- Being punctual
- Dressing appropriately
Skills include:
- Managing time well
- Meeting deadlines
- Offering positive contributions in meetings
- Prioritizing work effectively
- Communicating effectively
- Speaking appropriately to each audience without patronizing or putting people down
- Having the ability to achieve the expected result
- Giving appropriate feedback in real time to their co-workers and supervisor
- Exhibiting problem-solving perseverance
- Being knowledgeable about the job, the organization, and so forth
Frederick National Laboratory for Cancer Research conducts its professionalism standards survey using SurveyMonkey or Google Surveys. The survey should include many appropriate behaviors and skills for ranking. Respondents rank the behaviors and skills according to how important and urgent they are for the workplace. Some important behaviors may not always be practical . The survey should also give people a chance to evaluate the prevalence of the behaviors and skills. Some behaviors and skills may already be highly prevalent.
The survey can be stratified by leaders and managers and the rest of the staff. Any differences between leaders and managers and the rest of the staff can then be identified.
Along with setting standards for professional behaviors and skills, it is important to set standards for avoiding unprofessional behaviors and ensuring professionalism standards are set up so staff are encouraged not to behave unprofessionally. Unprofessionalism means not conforming to the standards or accepted code of conduct of a profession, whether face-to-face or in a virtual environment.
Surveys by the Center for Professional Excellence identified many unprofessional behaviors, including:
- Inappropriate relationships
- Blaming
- Breaches of confidentiality
- Lack of hygiene
- Inappropriate self-disclosure
- Exploitation (money or gifts)
- Getting emotional or flying off the handle
- Bullying
- Physical or verbal intimidation
- Use of profanity
Any of these unprofessional behaviors that are devastating to a specific workplace must be specified so that people know the importance of the established professional behaviors. In some organizations, physical or verbal intimidation and use of profanity are considered serious.
After reviewing survey results, staff who are working on establishing a workplace-specific culture of professionalism must develop a code of professional conduct. The code should list what is expected. Once the code of professional conduct has been developed, it must be disseminated. Visual cues such as infographics or a hard copy code of professional conduct are important for reminding people about the professionalism standards. If the workplace is physical, visual cues can be placed in the conference room or other areas. Professionalism standards can be posted on the website and mentioned at the beginning of meetings.
People must know the consequences of not following the professionalism standards. A standard pyramid for promoting professionalism shows that an egregious breach of the standards, such as physical or verbal intimidation or the use of profanity, immediately goes to a guided intervention or a disciplinary intervention.
A single concern about a minor breach can be handled informally with a cup of coffee to discuss the breach. If there is a pattern of breaches, then an awareness intervention or a more formal discussion is necessary. If the pattern persists, authority steps in for a guided or disciplinary intervention. About 98% of professionalism standard transgressions end after an informal discussion because people say that they did not know they had breached the standards or realize that their behavior was unprofessional.
Monitoring and Metrics
Determining the monitoring and metrics for the professionalism standards and providing support to participants is the third phase of establishing a workplace-specific culture of professionalism. The survey is an important baseline that shows how prevalent people believe certain behaviors are in the workplace. The staff working on the professionalism standards must roll out the monitoring plan and provide options for small groups to discuss challenges.
Table 5 provides an overview of the monitoring plan, metrics, and support. In determining the monitoring plan and metrics, it is important to consider the following questions:
- Who?
- Of whome?
- What?
- When?
- Where?
- To whom?
“Who,” “of whom,” and “where” cover the monitoring setting. “Where” is the environment, such as by telephone. The frequency of the monitoring, the “when,” must also be determined. “To whom” is who will be involved in the discussion about the monitoring metrics.
How the monitoring and metrics will be developed and implemented must also be considered. For example, if documentation is developed, staff must determine the type of documentation to develop and use. Once the plan has been agreed upon, staff must evaluate and report the metrics to leadership and management. The metrics should also be reported to all employees who participate in the professionalism standards.
Staff must also provide support to employees on the professionalism standards. Widespread distribution of monitoring data is one way to provide support. Some companies have a standing staff meeting agenda item to discuss important issues. The code of professional conduct can be one of the issues discussed. An option for providing anonymous feedback should also be available. Focus groups can be held around areas of concern related to the code of professional conduct.
Conclusion
This article has provided a three-phase process for establishing a workplace-specific culture of professionalism composed of:
- Establishing the need and providing an informational overview
- Determining the professional behaviors to be encouraged
- Determining monitoring and metrics and providing support to participants
Frank Tyger, a columnist from the Trenton Times, said, “Professionalism is knowing how to do it, when to do it, and doing it.” Professionalism is a combination of behaviors and skills, and all employees must know the professionalism standards of the workplace and buy into them.
As actor Lily Tomlin said, “The road to success is always under construction.” Professionalism standards and how they are monitored are different now due to the COVID-19 pandemic. As clinical research sites move toward a new normal in the workplace, professionalism standards may continue to change. This requires flexibility to collect the right data and make the necessary changes to the professionalism standards.
TABLE 1
Center for Professional Excellence Survey
TABLE 2
Evaluating Professionalism
- Based on expectations or standards
- Situational in nature
- Strongly influenced by culture
- Common parameters for both individuals and groups:
- Communication
- Punctuality
- Competence
- Demeanor
TABLE 3
Establishing the Need for a Professionalism Standard
TABLE 4
Determining the Professional Behaviors to be Encouraged
- Collect input as many ways as possible
- Provide examples
- Request suggestions
- Conduct focus groups
- Conduct surveys to select behaviors, ethical standards, and skills/knowledge to be encouraged
- Communicate survey results
TABLE 5
The Monitoring Plan and Metrics and Support