Professionalism in nursing, midwifery and the allied health professions: report

6. Conclusion

Don Berwick, writing for an audience of general practitioners, observed that today's healthcare workforce must "embrace the authority and autonomy of patients" and become much more focused on cooperation, teamwork, inquiry and dialogue than previous generations were required to do.^[60] This call for an adjustment to the central components of professionalism reflects the context and cultural sensitivity of the concept itself, and the need to evolve and reflect external expectations as well as internal drivers.

Professionalism is widely accepted as a central element of health care, but it is a complex and multifaceted concept that is often difficult to define. Consequently, it is frequently described in terms of its absence and the negative values, behaviours and relationships that are demonstrated when things have gone wrong. The emphasis should therefore shift to reinforcing the positive and professional behaviours that are expected of staff and to articulating how they can be motivated and supported to enact the quality agenda.

Professionalism is learned in many ways and in many contexts - the internal and external drivers interact with and reinforce one another and may exert differing degrees of influence at different stages in a practitioner's or support worker's career. As has been observed elsewhere in this report, the particular influence of a culture, system, framework, standard or patient/service user encounter will vary depending upon circumstances.

A collective desire to reinvigorate professionalism in Scotland's NMAHP and wider healthcare workforce is likely to come from a combined will to effect change and to see it sustained over time for the benefit of patients and service users. National standards and codes and quality education and training are important to achieving this, but it is individual self-regulation along with organisational support, and shared and consistent leadership and role modelling, that may carry the greatest potential for revitalising professionalism in Scotland in the 21^st Century.

Next steps

In Scotland, this report will be presented to the Coordinating Council for the NMAHP Contribution to the Healthcare Quality Strategy, which is chaired by the Chief Nursing Officer. It is anticipated that the Council will consider the recommendations and advise on their practical application to NMAHPs and that the Scottish Government's Quality Alliance Board infrastructure action group on workforce issues will consider their applicability to the wider health and social care workforce. In England, Wales and Northern Ireland, it is anticipated that the chief nursing and allied health professions' officers will consider the report and its potential application to NMAHPS and the wider healthcare workforce in their jurisdictions.