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Policy on Professional Conduct

Questions, suggestions, and concerns regarding this policy are welcomed, and should be directed to the UW Medicine Continuous Professionalism Improvement Committee (ghd@uw.edu).

Policy

UW Medicine is committed to high standards of professionalism in patient care, research and education and related activities that support them among our faculty, staff, trainees, and students. We expect our community to maintain these standards while present on campus or during travel representing UW Medicine. Professionalism is integral to our mission of improving health and includes demonstrating excellence, equity, respect, integrity, compassion, altruism, accountability, honesty, and service in all endeavors and creating an environment supportive of diversity in ideas, perspectives, and experiences. All individuals in our UW Medicine community are responsible for creating an inclusive environment where every person is valued and honored.

Historical context and intent of this policy

The concept of medical professionalism initially centered on discussions about commercialism and conflicts of interest. The lack of a consensus definition of professionalism and a recognition of the impact of racism, sexism, and other forms of bias in the subjective evaluation of professionalism within the hierarchy of academic institutions are important aspects in community discussions and professional development for learners. Professionalism has been used to inhibit personal expression, and has been weaponized against those not historically represented in academic medicine and science (e.g., restricting and labeling hairstyles such as dreadlocks as unprofessional). In recognition of the unintentional impact of professionalism policies, we acknowledge this as a living community document that will be revised over time. As a community, we agree that the policy on professional conduct will embody these goals: to create an environment to effectively serve our community, care for patients and their families, teach our learners, advance science, and allow all members of our community to thrive in their work.

We are committed to actively working towards an inclusive environment that honors the diversity in our community and equips all community members to recognize and interrupt unprofessional behaviors, holding our members accountable when we fall short of these goals. All members of the UW Medicine community are expected to conduct themselves in a professional and ethical manner with colleagues, patients, and the public. In particular, leaders in our community are expected to model, promote, and advocate for a strong and visible culture of professionalism, recognizing their obligation to those who may feel unsafe or unable to speak up or intervene.

The intent of this document is to provide unified and intentional principles pertaining to professional conduct across the nearly 30,000 individuals in the UW Medicine community of faculty, staff, trainees, and students. Local environments (e.g., departments, classrooms, laboratories, hospitals, clinics) may have additional specific policies pertaining to professional conduct. Professional conduct expectations are reflected in orientation, offer letters, merit evaluations, our UW Medicine website, and promotion criteria. These expectations guide each of us in our work across the organization and provide consistency with the values and principles contained in this policy. The implementation of this policy and decisions regarding corrective action based on the failure to abide by the policy follows local and/or university processes.

Working definitions, Values, and Principles

Dedication to excellence and continuous improvement represents dedication to quality of care, research inquiry, and teaching effectiveness. Excellence includes promoting and cultivating an institutional culture of equity and diversity in all its forms. It also includes innovation and collaboration. Pursuit of excellence should be accompanied by respect, integrity, compassion, altruism, and accountability.

Equity is the fair and just treatment of members of our community through the creation of opportunities to address the injustices that lead to perpetually underserved and underrepresented populations. This should be applied to all members of our community regardless of race, ethnicity, language, religion, age, spiritual practice, sexual orientation, education level, gender identity or expression, socioeconomic status, mental health, or ability.

Inclusion is an active practice of developing policy, resources, processes and supporting behaviors to strive for equitable access to opportunities and resources for people who might be excluded, historically marginalized, and/or minoritized.

Div​​ersity is integral to excellence, and refers to the variety of personal experiences, values, and worldviews arising from differences of culture and circumstance. Such differences include race, ethnicity, language, religion, age, spiritual practice, sexual orientation, education level, gender identity or expression, socioeconomic status, mental or ability status, geographic region, and more. The aims of diversity are to broaden and deepen our experience in all areas of learning and work that supports our mission of improving the health of the public. For the aims of diversity to be fully realized, the institutional culture must be one of inclusion with resources and opportunities distributed equitably, without undue bias, and with representation of diverse perspectives and identities seen at all levels of the organization.

Respect includes actions that recognize the inherent dignity and value of all persons and that seek to understand the perspectives of others. Working to achieve effective communication and acknowledging power differentials (formal or informal) are key to fostering mutual respect and trust.

Integrity refers to honesty in all interactions and upholding high moral and ethical standards in all endeavors.

Compassion is recognition of suffering and acting to alleviate physical, spiritual, and emotional pain. Compassion must also extend to oneself, recognizing that self-care is a key element of personal well-being which enables each community member to function at their highest capacity in their professions.

Altruism reflects a selfless concern for others and a commitment to advocate for the needs and interests of others.

Accountability refers to accepting responsibility for one's behavior and striving to uphold professional standards, as well as acknowledging that- as members of a larger community- we answer to one another for our conduct and outcomes. Accountability includes working to recognize and address one's own biases (conscious and implicit) and mitigate their impact on our behavior as healthcare professionals, teachers, scientists, and learners. Accountability includes assisting UW Medicine in recognizing and addressing institutional racism and other forms of bias and taking action that demonstrates intolerance of discrimination, in contrast to condoning or perpetuating discrimination through inaction.

Accountability to each other includes taking action to address unprofessional and/or harmful or destructive behavior. Leaders must recognize their responsibility to respond and intervene. It is incumbent on all of us to address unprofessional behavior when we see it. Action can take many forms ranging from direct and immediate discussion with the individual(s) engaging in unprofessional behavior to reporting observations to a superior.

Each of us has a personal responsibility to improve the overall environment. It is also important to recognize that all of us have, or will, cause harm in some way to another member of our community. We recognize that we learn harmful behaviors and language and replicate them. When people cause harm, it is possible for that harm to stop and for those involved to find another way to offer community restoration, support, and healing. Being made aware of one's own behavior that was intentionally or unintentionally unprofessional is an opportunity for acknowledgement, correction of behavior, and personal growth.

Service refers to our work with the purpose of honoring and putting the needs of the people we serve at the center of our processes and policies.

Professionalism in clinical practice settings includes adherence to the UW Medicine Service Culture Guidelines and includes, but is not limited to safeguarding the privacy and confidentiality of patient information, communicating effectively in an interprofessional environment, observing established standards for patient safety and timely completion of medical records, participating in quality improvement initiatives, exercising cultural humility, reporting errors, and following rules for billing and compliance. This includes accurate reporting of clinical and educational work hours, patient outcomes, and clinical experience data. We should strive for a collaborative environment, respecting all members of the care team, employing collegial, non-threatening treatment of all faculty, staff, trainees, and students All healthcare professionals bear a responsibility to arrive for work adequately rested and ready to care for patients, to be observant, to intervene, and/or to escalate their concern about colleague fitness for work. This includes recognition of impairment, including from illness, fatigue, and substance use, in themselves, their peers, and other members of the health care team. Related is the recognition that under certain circumstances, the best interests of the patient may be served by transitioning care to another qualified provider.

Professionalism in the conduct of research includes but is not limited to fostering a collaborative environment, and employing collegial, non-threatening, and fair treatment of research team members which include faculty, staff, trainees, and students. Research should be undertaken and conducted in a manner that is inclusive of diverse opinions and ideas.

Research studies should include participants from traditionally underrepresented groups (e.g., race, ethnicity, gender) as appropriate to the scientific question under study and supporting the UW Medicine commitment to identify and eliminate health disparities.  

Professionalism in education includes but is not limited to creating an inclusive environment respectful of diverse experiences and perspectives, fostering discussions that respect the dignity and humanity of all members, a commitment to the highest standards of scholarship, innovation in teaching, and leadership through modeling of life-long learning.

Professionalism in administration includes but is not limited to respecting the culture and values of the UW Medicine community, committing to collegial partnerships with co-workers one is responsible for and responsible to, supporting the work of collaborative teams, fostering an environment that supports speaking up and respects diversity of thought, recognizing the needs of patients and our professional community, and showing dedication to the full mission of the institution.

Ethics in decision-making and relationships means ensuring decisions are free of bias or influence, guaranteeing that personal and professional relationships do not present a conflict that threatens (or is perceived to threaten) the integrity of the decision, and removing oneself from decisions where fairness may be compromised, especially decisions made in the context of supervisory relationships.

Ethical business practices means the wise and fair use of resources and practices that comply with laws, regulations, and policies governing conflicts of interest, sponsored research, and the delivery of and reimbursement for healthcare services. Business practices should be transparent and fair. A continuous evaluative process should examine and address how practices may be exclusionary and/or perpetuate disparities.

Ethical research practices means practicing intellectual integrity, ensuring the welfare of human and animal research subjects, exercising diligent and unbiased acquisition, evaluation, and reporting of scientific information and adhering to university regulations for the conduct of research.

Unprofessional behavior means behavior that violates laws or rules regarding discrimination and harassment, and/or violates rules of professional ethics (including professionalism in clinical, educational, research or business practices), or is disrespectful, retaliatory, and/or destructive.  Bullying is unprofessional behavior that misuses power to control or harm others.

A culture of workplace, emotional, educational, and patient safety requires trust in reporting or interrupting unsafe conditions and unprofessional behavior to ensure high-quality patient care and educational environments. We value members speaking up in the moment and making such reports. We have built various reporting opportunities for our community and will continue to strengthen and develop these options to best serve our community

Rules of professional ethics mean the adoption of ethical standards that have been established by external professional societies and associations (e.g., The Joint Commission, American Association of Medical Colleges, National Institutes of Health) or by UW Medicine entities for various professions (e.g., physicians, nurses).

Discrimination and harassment is defined in University of Washington (UW) Executive Order 31. As of the effective date of this policy, this includes discrimination or harassment on the basis of race, color, creed, religion, national origin, citizenship, sex, age, marital status, sexual orientation, gender identity or expression, disability, or military status.

Disrespectful, retaliatory, or destructive behavior includes, but is not limited to, behavior that in the view of reasonable people has a negative impact on the integrity of the healthcare or research team, the care of patients, the education of students or trainees, or the conduct of research, such as:

  1. Physical assault or other uninvited or inappropriate physical contact;
  2. Shouts, profane or offensive language;
  3. Degrading or demeaning comments;
  4. Discriminatory or harassing behavior or language
  5. Retaliation in response to a person raising concerns about a behavior that may violate laws or policies (such as discrimination), or present a threat to safety or security
  6. Threats or similar intimidating behavior, such as coercion, as reasonably perceived by the recipient;
  7. Exploiting, neglecting or overworking those in subordinate positions;
  8. Unreasonable refusal to cooperate with others in carrying out assigned responsibilities;
  9. Failure to respond to repeated inquiries within a reasonable time frame; and
  10. Obstruction of operational (e.g., educational, clinical, research) goals

Procedures and values in action

Engagement of our community to advance professional values. All members of our community should seek opportunities to acknowledge, promote, and celebrate professionalism in our environment. Leaders in our community are especially accountable for creating a culture of professionalism in their own units by exhibiting professionalism, recognizing individuals and teams that exhibit best practices and demonstrate core principles, finding opportunities to convey the importance of professionalism in our shared work, and making time for collaborative, inclusive dialogue around challenging issues. To ensure that the professionalism standards outlined in this policy are upheld, those aware of unprofessional behavior are responsible for raising their concerns within a reasonable time frame so that the behavior can be addressed and remediated as appropriate.

Incorporating the principles of professionalism into applicable documents. UW Medicine units should incorporate the values and principles in this policy as appropriate into their policies, procedures, and practices. Professionalism expectations should be included in offer letters, merit evaluations and promotion criteria. Expectations and any available measures of professional behavior should be specifically highlighted in annual performance reviews, and in documents that relate to situations where the evaluator becomes aware of substantiated acts of unprofessional behavior.

Supervisor responsibility. Supervisors, including healthcare and research team leaders, and teachers, are expected to exhibit professional behavior, set clear expectations, and manage performance of their teams in accordance with the standards in this policy through regular communication and timely performance reviews. Supervisors must confront unprofessional behavior effectively and engage in conversations that may be difficult or uncomfortable. In these challenging situations, supervisors should draw on existing resources including their own supervisors, administrative leadership, and human resources offices. Supervisors are expected to respect diversity of opinions and will not retaliate against members of their team. Finally, supervisors are expected to address professionalism concerns and deficiencies through routine performance evaluations, counseling, discipline, or other action as appropriate in accordance with policies and procedures within the UW, UW Medicine, affiliates and partner entities.

Teaching responsibility. Teachers and learners are expected to maintain the highest standard of professional behavior in all aspects of training and education. Teachers are expected to provide role modeling that will enhance the learners' ability to incorporate appropriate behaviors into their professional development.

Mentor responsibility. Mentorship is a professional alliance in which individuals work together over time to support the personal and professional growth, development, and success of the relational partners through the provision of career and psychosocial support. Mentor relationships can occur formally and informally. Mentors bear responsibility for sharing knowledge and expertise with mentees, may sponsor mentees with opportunities to advance their careers, and should help in shaping professional development. Mentors will look for ways to counterbalance the inherent power differential found in a mentoring relationship and will promote the welfare of mentees in ways that increase mentee development, engagement and empowerment. Mentors should establish clear expectations for mentees to create a successful working relationship.

For individuals covered by collective bargaining agreements. UW Medicine managers and supervisors are expected to apply this policy in a manner consistent with the principles of just cause, as well as other applicable requirements of the labor agreements. We expect all members to work cooperatively with respect and empathy, recognizing and holding in balance the complexity of varying perspectives and priorities.

For hospitals and clinics that are part of UW Medicine, this policy is intended to define "professionalism" at the UW Medicine level in accordance with The Joint Commission standards. Under this policy, "desirable behavior" means demonstrating professional conduct as described above and "disruptive behavior" means engaging in conduct that is unprofessional as described through this document. The hospitals and clinics will have policies and practices implementing these principles and may further define expectations regarding appropriate conduct.

For individuals engaged in travel to locations outside UW Medicine (e.g., conferences, sites of practice in our five-state medical school region – Washington, Wyoming, Alaska Montana and Idaho, (WWAMI), off-site research environments) professionalism standards as described should be maintained in all settings.

For individuals using personal social media communication Individuals should refer to local policy or UW Medicine Social Media policy and Social Media Networking guidelines.

Mechanisms for addressing unprofessional behavior UW Medicine does not condone or tolerate unprofessional behavior, and individuals who engage in such behavior may be subject to disciplinary action up to and including termination. Supervisors are expected to address unprofessional behavior as described here and there are existing processes for addressing student conduct issues outlined in the Medical Education Program Policies and Handbook. There are processes for addressing faculty members' rights to resolve or adjudicate issues under the Faculty Code. Individuals should contact their supervisor for help in determining whether a particular behavior is covered by an established procedure. Members of our community at all levels may raise concerns and/or ask for support through a number of avenues depending on the particular circumstances. The many avenues of redress outlined below are meant to provide viable options that can be pursued alone or in conjunction with other options. Members of our community seeking to raise concerns may seek counsel from within the member's administrative structure, supervisory chain of command or one of the offices responsible for addressing conduct in violation of UW policies.

For certain types of concerns, a particular avenue may be most appropriate, or even required by UW policy. For example, Administrative Policy Statement 46.3 (Resolution of Complaints Against University Employees), contains information and processes for addressing complaints about employees, including violations of the University's non-discrimination policy (http://www.washington.edu/admin/rules/policies/APS/46.03.html) and other concerns. Detailed administrative or contractual processes also exist to address specific types of complaints including classified and professional staff complaints, whistleblower complaints, and patient complaints.

Avenues to raise concerns include but are not limited to the following: (1) informal and collegial one-on-one resolution; (2) bringing the issue to a supervisor or the next highest individual of authority, if the concerns involve the supervisor; (3) following applicable grievance procedures under collective bargaining agreements; contacting (4) Human Resources; (5) the University Complaint Investigation and Resolution Office (UCIRO); (6) the University Title IX office; (7) UW Safe Campus; (8) the University of Washington Ombud; (9) the UW Medicine Bias Reporting Tool and/or other local reporting tools may be also considered. UW Medicine is committed to investigating, monitoring, and addressing concerns in a timely manner.

Approved by, Paul G. Ramsey, M.D. CEO, UW Medicine
Executive Vice President for Medical Affairs and Dean of the School of Medicine,
University of Washington
November 2021

This Policy is a living document that was implemented in 2009, revised in 2016, 2017, and most recently in Fall of 2021 by the 2021 Continuous Professionalism Improvement (CPI) Committee with engagement from UW School of Medicine community members including the following: nursing leadership, members of the Committee on Minority Faculty Advancement, members from the Office of Healthcare Equity, Office of Faculty Affairs, leadership from Graduate Medical Education, Academic Affairs, Human Resources (UW Medicine and School of Medicine), Hospital Medical Directors, UW Medicine Vice Presidents, and members of the Medical School Executive Committee and Clinical Operations Roundtable.

We would like to thank these groups and the individual stakeholders across UW Medicine who offered their time and energy in giving us feedback to the drafts of the 2021 revisions to the Policy on Professional Conduct. The UW Medicine CPI committee was expanded in membership for PoPC revisions to include people throughout our community striving for diverse representation and aiming to center historically and currently underrepresented voices. The Office of Healthcare Equity, Impact Tool was essential in this work. Please send feedback regarding this policy via redcap or to the Chair of the CPI Committee, Giana H Davidson, MD, MPH - mailto:mghd@uw.edu.

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