Professional Pyramid – Vanderbilt Center for Patient and Professional Advocacy
The Professionalism Pyramid was developed by the Vanderbilt Center for Patient and Professional Advocacy (CPPA), a US-based academic centre working in the area of healthcare leadership and professional accountability. The pyramid is a tool for guiding employer responses to unprofessional conduct, through a structure of escalated communication as patterns of unacceptable behaviour develop.
The tool is underpinned by research indicating that most workers conduct themselves with propriety, but all are subject to lapses and may engage in occasional acts of inappropriate conduct. Workers who exhibit a pattern of inappropriate behaviour need to have their conduct addressed. The level of intervention depends on the circumstances of a particular situation, and managers’ judgement plays an important role in deciding how to proceed.
The tool is often used to address incidents of workplace sexual harassment. Inappropriate jokes and comments fall at the lowest level of the pyramid, while sexual assault is at its peak, with a range of other behaviours in the middle. If a worker engages in more serious conduct, or the same conduct repeatedly despite warnings, they will be subject to escalating intervention. The stages of the pyramid are demarcated by dashed lines (see diagram below), indicating managerial discretion on the appropriate level of intervention.
Managers using the tool remind workers at each intervention that they must not retaliate against victims or others involved in a complaint. The CPPA emphasises that managers should be equipped and supported to appropriately respond to workers’ reactions to interventions.
All workers are trained in the operation of the pyramid at induction and regularly afterwards. A hotline is available to guide managers on using the tool in specific cases, which also allows for central data collection. An oversight group, comprising doctors, human resources officers, and diversity and inclusion officers, meets quarterly to monitor the operation of the tool.