Health care has a humility problem, according to Barret Michalec, director of Arizona State University's Center for Advancing Interprofessional Practice, Education and Research and associate professor in the Edson College of Nursing and Health Innovation.
“There’s an embedded occupational status hierarchy within health care that one health profession might be 'better' or 'more knowledgeable' than another,” Michalec said. “Doctor, nurse, PA, clinical social worker, physical therapist, occupational therapist and others, they’re all stratified in our minds in terms of who knows what, who can do what, and who is smarter, had harder training, or is more important. That value ladder gets taught to us as patients and to health profession students in various implicit and explicit ways. It’s totally socially constructed, but it has real impact and real consequences.”
Whether you work in health care or you’ve been a recipient of services as a patient, you have likely experienced this hierarchy in action and may have even unknowingly contributed to it.
Michalec is quick to point out that this is the result of deeply entrenched cultural norms and practices within both the health professions and health education.
“They (students) are siloed and socialized in their own professional education pathway, and while interprofessional education is supposed to bring students together it may only do that in certain ways, like one-off events, or focusing purely on assumed clinical roles.”
And humility, which for these purposes is defined as “an accurate assessment of one’s abilities, achievements, as well as gaps in knowledge and limitations,” might be just what’s needed to break through the hierarchies and break open the silos.
With a good grasp of the problem, Michalec is now focused on finding solutions. That’s where the Humility Paradigm comes in. This new research and educational initiative out of the Center for Advancing Interprofessional Practice, Education and Research is focused on promoting the values of humility as they relate to interprofessionalism in health care.
We spoke with Michalec to learn more about what this initiative will look like in practice and find out why he thinks this approach could fix health care.
Question: What does the Humility Paradigm look like in practice?
Answer: The Humility Paradigm is the title of this broad initiative and it’s a way for (the center) to package our work in this area. It’s like the north star for us. So we’re developing new educational programs like I-TEAM By Design and outlining our research agenda, but we’re also getting the word out through talks, podcasts, blogs and so on that promote the idea and the value of humility within health professions generally and interprofessionalism more specifically.
We really need to start drilling down into the concept, into the practice, into the theory to see how it plays out in social settings and health care delivery. As someone who does interprofessional education, I think it’s an essential element to advancing team-based care. And we’ve got to figure out how we can tap into that.
Q: How did this initiative come about and why is it needed?
A: The idea stemmed from my previous research on empathy. I was putting together the final report for a program funded by the Macy Foundation, and I realized that some of the major elements that I had been pushing through this program like empathy and emotional contagion were all extremely valuable, but something was missing.
It felt as though the health profession students were getting the gist of interconnectedness and shared values but I knew in the long term that they were going into a professional practice setting that would really be emphasizing the status hierarchy amongst the professions, and that was something that empathy wasn’t going to change.
We need to have a paradigm shift in health professions education and practice, one that focuses more on connectedness, shared values and shared vulnerabilities and less on strict, rigid professional role differentiation. That’s the Humility Paradigm, and we think interprofessional education needs to start tapping into what we’ve termed "professional humility."
Professional humility encompasses the fundamental tenets of humility but also promotes an ability and willingness to understand the strengths and limitations of one’s own health profession as well as acknowledge the skills and abilities of other members of the health care team, which includes patients and their caregivers.
Q: How can professional humility help improve health care?
A: We know that team-based collaborative care has multiple benefits. Better health outcomes, enhanced work-related satisfaction, it’s more cost-effective and increases patient safety. So what we need to be doing is embedding team-based, interprofessional care into regular, day-to-day health care delivery practice. Although we see that in particular areas of health care and various interventions, it’s certainly not the norm.
In order to do that, we need to infuse professional humility at an early stage of education and training and thread it consistently throughout. It needs to be an essential and consistent element of professional development, and we need to be providing opportunities for health professionals to develop their humility-related muscles early and often.
Because humility has so much to do with status, I think that by advancing and enhancing professional humility as a trait and practice among health professionals we can actually make a dent in the occupational status hierarchy that plagues our health care system and really diminishes true team-based care. I also think professional humility is the vehicle to authentically engage patients and their caregivers in clinical decision-making.
Q: What do you want patients to know about this work?
A: At (the center), we’re developing innovative ways for providers to connect and communicate with one another to provide better, safer and more cost-effective health care. A key element of this has to be patient-centered care delivery and the health care team must include the patients and their caregivers. This is why we’re so focused on humanism and promoting the shared human-ness of health and health care.
One of the biggest barriers to patient-centered care delivery is the socio-emotional distance that is somewhat assumed between providers and patients. A lot of that has to do with perceived status. We want to minimize the status differentials between providers but also between the provider and the patient so that the patient is also seen as a valuable team member.
And, it’s important that they know we are invested in making a health care system that works with and for them. ASU is a public research university and the work we do translates directly into our communities which is one of the reasons I’m so excited about this initiative.
Q: What are some of the research aspects of this initiative you’re currently working on?
A: One of the things coming soon will be a paper on humility and social status. As I was exploring the research on humility I discovered that the literature doesn’t address issues related to humility and race and gender. Although this paper isn’t specific to health care delivery, it is an essential early step in the development of the Humility Paradigm and will lay the foundation for our future research.
It’s a key piece because we think of humility as this wonderful and consistently socially beneficial thing. But in certain situations, if you’re a person of color or a woman, for example, the idea of being perceived as humble or not could actually be detrimental. This is something that just hasn’t been talked about — there’s this elephant in the room. Humility may not be socially beneficial for everyone.
This needs to be dissected before our humility research can move forward because this specific paper will also have implications for how we frame the notion of professional humility within health care delivery and health professions education.
Q: Anything else you think is important for people to know?
A: Humility and being humble do not mean that you’re not proud of yourself or your accomplishments, or that you lack self-confidence or assertiveness. It's actually quite the opposite. With advancing the professional humility concept and the Humility Paradigm in general, we’re not trying to efface doctors or nurses or the skills and knowledge they bring. We’re trying to level the playing field a bit, to call out the occupational status hierarchy that’s been hiding in plain sight in health care delivery, and utilize humility as the flashlight.
We think that teaching and practicing humility may be an effective way to promote authentic interprofessional, team-based care and a way to truly engage patients and caregivers in interactions and decision-making. We need to get beyond the self, beyond the professional role-focus, beyond the silos and echo chambers, which are more like echo chasms, and acknowledge, accept and appreciate our interconnectedness and shared vulnerabilities. With the Humility Paradigm, we’re hoping to advance new ways of thinking about and practicing interprofessionalism while also expanding humility theory in general.