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Title: Understanding the stakeholder's perspectives on professionalism in healthcare : a cross-cultural analysis
Author: Khan, Junaid Sarfraz
ISNI:       0000 0004 9352 1488
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2020
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The term 'medical professionalism' lacks a universally agreed definition. The purpose of this research was to understand the meanings made by a range of stakeholders - doctors, patients, health profession students, healthcare policymakers, nurses and other allied healthcare professionals - of their lived experiences and perceptions of medical professionalism, across the demographically, economically and socio-culturally divergent province of Punjab in Pakistan. The focus was on how different individuals involved within healthcare delivery would make sense of the term depending on their lived experiences and socio-cultural standing within the community, the prevalent culture, the context and setting and other less understood factors. It seemed possible that comparisons of this understanding between the Pakistani study group and other parts of the world (as represented in the literature) would help in developing a more nuanced and useful definition of medical professionalism. The following three questions guided the research: 1) What are the perceptions of doctors, nurses, students, administrators and policymakers in Punjab, Pakistan, regarding medical professionalism? 2) How does this sense-making of medical professionalism amongst stakeholders in the Punjab, Pakistan, compare with the evidence available in the international literature regarding sense-making by stakeholders in other regions of the world? 3) How do the perceptions and understanding of medical professionalism differ amongst various stakeholders within the healthcare delivery system of the Punjab, Pakistan? The study design was qualitative and a case study approach was employed. 530 individuals took part in thirty-eight focus group discussions, with 8-15 participants in each group, in various settings across the province of Punjab, comprising doctors, health professional students, patients, policy-makers, nurses and other allied health professionals. Thematic analysis was undertaken of the transcribed data. Four distinct superordinate themes were identified: VALUES-DRIVEN, ADEPT, POTENT LEADER and SUPPORTED. These four themes were common to all stakeholder groups. All resonate closely with themes in the international literature, although the theme SUPPORTED appears to draw together issues in a way unique to the Pakistan context. There were greater variations in findings from amongst the stakeholder groups at the subordinate themes and further lower levels of thematic analysis. Related to their different contexts and experiences, different stakeholder groups emphasised the following aspects: professional identity; the need for training; the support for professionalism (or lack of it) within their working environment; the link between religious beliefs and professional behaviour; cultural expectations of the doctor-petient relationship. It is concluded that understanding of medical professionalism vaies among stakeholders and depends on context, culture, environment and many other factors identified in this research. Professionalism, thus, is not a static, stable construct and it is not possible to confine it within a single generic definition on account of its cultural and situational dependency. It is a dynamic and constantly evolving phenomenon which cannot be represented by the type of linear, unidimensional model typically presented by the majority of researchers. This research study lays the foundation for further research in this area, especially in trying to understand how best to promote medical professionalism so as to ensure that healthcare encounters are meaningful and satisfactory for all concerned.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral