The Forum

3 ways health care providers can fight racism—today and in the future

by Rachel Zuckerman and Asya Igmen

This is the second instalment in our 'Global perspectives on racism in health care' series. Read the first instalment here.

10 takeaways: How to build true health equity amid a global pandemic

Health care organisations are powerful institutions. In addition to providing lifesaving care, they often have significant political clout and are major employers in local communities. That's why health care providers are uniquely positioned to address racial injustice and health inequities.

In recent weeks, health care organisations globally have published statements condemning structural racism, police brutality, and health inequity, including Cleveland's three largest hospitals and NHS England's chief executive, among others. This is a crucial foundation—but what comes next? Below are three places to start.

1. Your staff

As employers, health care providers must turn inward to support, safeguard, and invest in people of colour within our own workforce, including Black and Indigenous staff.

In the immediate term, lend support to the Black members of your workforce.

Racism is unfortunately not a new experience for most people of colour, but coverage of the ongoing Black Lives Matter protests and frequent reminders of police brutality can be especially draining. Encourage managers to remain in active-listening mode with Black, Indigenous, and people of colour (BIPOC) staff and employee networks dedicated to people of colour, and embed support without putting the burden on Black staff to lead anti-racism work.

It's also critical to ensure the safety of our BIPOC staff, for instance through changes in risk assessments to include race (as England's NHS has recently done) and instituting zero tolerance policies against abusive behaviour towards BIPOC staff.

In the longer term, prioritise creating a genuinely inclusive workforce that invests in people of colour.

We encourage providers to forge a strategy to facilitate equitable access to career development resources, increase the number of BIPOC individuals in positions of leadership, and adjust promotion criteria and policies to be fairer and more transparent.

This isn't just the right thing to do; it also benefits our organisations. Data show that diverse and inclusive institutions perform better. For example, organisations with inclusive cultures are twice as likely to meet their financial targets. Plus, organisations that create environments where diverse employees thrive will be better positioned to serve diverse communities.

2. Your patients

Health systems exist to serve people and help them live better and healthier lives; to truly deliver on that mission, we need to address health inequities in our own patient populations.

In the immediate term, begin collecting data to better understand racial disparities.

Our colleague Darby Sullivan recently recommended regularly collecting and analysing race-specific data as a crucial immediate step. This data can help demonstrate the scope of racial inequities to staff or boards, achieve buy-in for operational changes, and identify blind spots to target prevention efforts.

In the longer term, change clinical, operational, and strategic processes to address point of care biases.

It may feel like it's out of our control to change many of the structures that perpetuate racial inequities—but clinical interactions with patients are squarely within our control as health care providers.

We can help clinicians reflect on where bias might arise, even unintentionally, in their encounters with patients and show them ways to mitigate those biases through shared decision-making tools and motivational interviewing.

At the institutional level, consider also how to embed preventive measures in workflows to remove triggers that magnify bias in decisions; for example, look for opportunities to hardwire evidence-based medicine protocols. Or consider changing policies to mitigate structural biases that perpetuate inequities. For example, New Zealand health care providers Capital & Coast District Health Board (DHB) and Hutt Valley DHB are prioritising Māori and Pasifika patients as they begin to reopen for elective surgery post-Covid-19.

3. Your community

As influential institutions, health care organisations can look beyond our immediate staff and patient populations to support change in our wider communities.

In the immediate term, use your powerful voice to call for change.

Health care providers are trusted members of society and health systems often have considerable political clout. You can use that to speak up about the inequities you see in health care and advocate for change.

This can happen at the individual level, such as through clinicians sharing their perspectives in opinion pieces or participating in protests in white coats. It can also happen at the system level: for example, Texas Health, a 29-hospital system in the U.S., dedicates staff to advocate for local and federal policies to help their communities.

In the longer term, serve as an anchor organisation for your community.

Anchor institutions are committed to harnessing their economic power to inclusively and sustainably benefit the long-term health and wellbeing of the communities they serve.

One great example is Rush University Medical Center, a 664-bed academic medical and trauma centre located in the U.S. Rush recognised that the inequitable distribution of resources in its own backyard has resulted in vastly different health outcomes. Residents of the primarily white neighbourhoods in downtown Chicago live, on average, 16 years longer than those in the primarily Black West Side neighbourhood.

In response, Rush has committed to leveraging all its assets—including hiring, purchasing, and investment—to promote equitability in the local economy. Among other efforts, Rush has focused on repairing trust with the community, creating career pipelines with high schools in under-represented neighbourhoods, and reengineering its supply chain to purchase from more community-owned businesses.

Commit today to the longer-term actions needed tomorrow

Right now, racial health inequities are dominating the news. At some point the news cycle will move on, but this work must continue for a long time.

Nothing is more damaging to community trust than parachuting in and out with temporary support. Make your commitment now and stick with the long-term investments needed to make a difference.

Addressing racism: Resources for health care leaders

At Advisory Board, we are committed to making a difference against the structural racism that is contributing to real health inequalities in our communities.

We want to help you make a difference too. As a start, we’ve gathered a list of helpful resources below.

Access the Resources