Health care organizations: Clean up your house first, then you can tackle racism in patient care


The new American Medical Association policy recognizing racism as a public health threat and providing an anti-racist approach to equitable care will have no effectiveness unless health care organizations get their own houses in order and actively do anti-racism work in their own institutions.

Although I’m not a health care provider, as a health care communicator whose role is dedicated to diversity, equity, and inclusion, I sit in rooms where health disparities in hard-hit communities due to systemic racism are regular topics of conversations. But in the hallways, on Zoom meetings, in texts and email conversations, I also learn about all how disparities due to systemic racism are rampant inside an institution and make organizational health equity seem like a faraway dream.

How can you fight to advance health equity and racial justice out in the community when you’re not doing the same within your own organization?

Black health care providers experience racism on all fronts, from patients, colleagues, and institutional leadership, yet they feel like they have no recourse or support from white colleagues or senior administrators.

In the United States, only five percent of physicians are Black compared to 56.2 percent of white physicians, which means very few places exist for Black providers to find support from colleagues who look like them. Representation matters. It’s hard to instill organizational changes when Blacks’ opportunities in leadership roles are far less than for their white counterparts. As a result, in many organizations, few Black providers exist in positions of medical senior leadership. Black workers, in general, also far more often experience microaggressions and overt racism. A 2020 study found that 79 percent of Black professionals have experienced racism in the workplace in the Midwest alone. All of these factors mean that their needs as medical professionals are often overlooked and disregarded.

After the murder of George Floyd and with the pandemic as a backdrop, stories from my Black provider and front-line medical staff colleagues began to quietly pour in about how their white peers and managers were silent in the wake of the George Floyd protests. This was apparently typical because these same individuals also ignored ongoing racism in the department. I heard stories of employees crying in bathroom stalls about the mistreatment they experience by racist managers, only to have to dry their tears and go back into that harmful environment shortly afterward. Many also shared valid complaints of racism, backed by evidence, but were too afraid of retribution by their managers to report them.

In response, our health care system developed the Racial Justice Action Committee made up of a cross-section of providers, front-line staff, faculty, and students to identify areas across the institution where we needed to dedicate anti-racist efforts to ensure equity. The organization was surveyed, and listening sessions and town halls held. Recommendations were then developed based on this feedback, senior leadership signed off, and the true work of implementation now begins.

To make health care spaces much more equitable for Black providers and medical care staff requires anti-racist work that centers on empathy and transparency. It’s allyship in action. White providers and managers need to take a pulse check and round with Black colleagues and direct reports to see how they’re managing. It’s learning to identify when Black providers may need support by implementing such resources as Mental Health First Aid at your institution, which provides training to help participants identify mental health and substance use issues. But putting these measures in place must also be accompanied by an atmosphere free of shame and judgment.

There are other things hospitals should also do. Put systems in place to help Black providers and staff know they have recourse that will not result in punishment or reprisal when they report racist experiences. Develop a governing body that thoroughly and fairly investigates complaints of racism. Work with the communications team to deliver messaging about this group and data that reflects results on an ongoing basis across the organization. Establish hiring, recruiting, and pathway programs so that the medical workforce mirrors the community it serves, which only improves outcomes.  

Though some people may view these efforts as preferential treatment, in reality, Black providers aren’t seeking favoritism but rather the same treatment that their white counterparts have been experiencing all along.

By taking active steps to address the racism within health care organizations, every provider, Black or otherwise, will feel better equipped to serve the communities experiencing health disparities. Having institutional knowledge on how to improve your own organizations helps foster better understanding of how to support these underserved communities. It’s a win-win. If you can do it for your patients, then you most assuredly can do it for your providers and staff in the institution.

The responsibility of systemic change lies with each of us individually, and if we each do our part, then collectively, we can move forward together and start chipping away at systemic racism in health care, which is the ultimate way to advance health equity — inside the organization and out.

Nikki Hopewell is a communications strategist.

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