Shared Principles in Practice

Robert White, MD

Presented through the courtesy of Pediatrix Medical Group

This discussion is included to illustrate one large practice group's approach to professionalism among its members.​

Philosophy

Pediatrix became interested in Shared Principles because of its utility in addressing behavioral concerns. Pediatrix had often needed to address behavioral issues amongst physicians, nurses, and nurse practitioners, and believed that implementing the Shared Principles review (a 360 degree review, that is with input from all with whom you interact—above, below, and at your level—including patients or families) would help to:

• elucidate and disseminate the Pediatrix view of the competency "Professionalism";
• create a systematic approach across Pediatrix as a whole;
• allow sites to create the standards locally within the boundaries of company policy
• set an agenda for setting personal performance thresholds or goals;
• identify perceived deficiencies in physician behavior;
• strengthen the unit team by valuing the perspective of all members, and
• foster a positive relationship within the communities served.

Process​

Plan

Each NICU group is asked to begin the Shared Principles process by developing the standards which then served as a basis for the 360 degree review in that particular practice. Neonatologists developed the listing of behaviors that they believed should be demonstrated by all members of the practice, with templates and review available at the corporate level. Through this process of developing the Principles themselves, each member of the group is provided the opportunity to "buy in" to the approach which is invaluable when addressing opportunities for improvement that may be identified through the survey.

Do

Each member of the group completes the annual survey. The opinions of other medical professionals with whom the group works are then solicited annually through a survey based on the Shared Principles. By including partners of the group, such as other physicians, RTs, pharmacy, nurses, NNPs, nurse managers, Director of Womens' and Childrens services, academic faculty leaders, etc, the group is able to develop a well-informed picture of how individual efforts, and efforts of the group, are being perceived. The survey results then become the basis for frank discussions amongst practice members aimed at ensuring that each individual is doing their utmost to represent the group in a professional manner.

Operationally, the survey is sent to identified individuals (whether by email or distribution of paper surveys at nursing meetings) by the regional Director of Operations for Pediatrix.

Study

After the regional PMG office has tabulated the responses, an "average" is developed for each individual (as well as the group) that includes any comments that may have been provided, in a way that preserves the anonymity of the respondents.

Following up on the results can be a delicate process, but one that is facilitated by the fact that all members of the group have already bought in to the process (the Principles are "fluid" so that any new member of the group has an opportunity to discuss the existing Principles with an opportunity to suggest alternatives or amendments to the listing).

Act

Identified "opportunities for improvement" (aka bad survey results) are handled on a case by case basis, and in each situation a corrective action plan is developed. In some cases, the corrective action plan may be directed for an individual but at other times it could require a new initiative for the group.

Survey results are also shared with unit leadership from the Hospital. Although the Principles are designed by and refer to the Neonatologists/physician staff of the practice, collaboration with unit leadership is crucial in addressing the identified opportunities for improvement and may also provide an opportunity for unit leadership to learn more about their staff. In subsequent surveys, responses are compared to the previous survey to gauge whether there has been movement in the participants' perceptions of the Pediatrix staff.

Spectrum of Work​ Responsibilities »​​​