ECRI: Healthcare Organizations Must Address Racist Behavior in the Workplace

Healthcare organizations must create an environment where it is unambiguous that racist behavior will not be tolerated, ECRI's top leader says.

A new report published by ECRI includes data on racist incidents at health systems and hospitals.

The majority of the racist incidents involved patients and family members making inappropriate comments related to race or ethnicity. These comments can have a negative impact on the mental health of healthcare providers—leading them to consider leaving their jobs at a time when workforce shortages are a significant problem at healthcare organizations.

The new report features data collected between July 1, 2019, and June 30, 2020. The data on racist incidents was drawn from more than 500 patient safety incident reports collected from health systems and hospitals nationwide.

The patient safety incident reports were broken into seven categories:

• Patients or family members making inappropriate comments about race or ethnicity (56%)
   
• Patients saying that others are racist or engaged in racist behavior (22%)
   
• Patients or family members saying that they received substandard care because of the patient or family's race or ethnicity (9%)
   
• Staff members making inappropriate comments about race or ethnicity (7%)
   
• Staff members saying management or a supervisor discriminated against them (4%)
   
• Patients requesting a healthcare provider based on race or ethnicity (1%)
   
• Patients or family members complaining that interpretation or translation services were not provided (less than 1%)

Addressing racist incidents at healthcare organizations

Racist incidents are not just a matter of bad behavior, Marcus Schabacker, MD, PhD, president and CEO of ECRI, told HealthLeaders.

"These incidents have negative consequences for patient safety directly and indirectly. If a staff member is exposed to racist comments, then they are going to be impacted in their emotional well-being. If they are not emotionally well—if they are frustrated or angry—they may not be able to provide the best care and they might not be as attentive to potential health issues of the patient as they could be. That is a direct impact on patient safety. If a staff member has racially motivated issues, they might not provide appropriate care to a patient," he said.

There are two primary ways healthcare organizations can detect racist incidents in the workplace, Schabacker said. "First of all, the leadership, administration, and management team must provide an environment in which employees and patients feel comfortable that they can report these issues, that they are going to be taken seriously, and that there are mechanisms in place for incidents to be reported. Secondly, it is helpful to have a dedicated member of the senior management team who is the advocate for reporting and is trained in dealing with these issues both on the staff side and the patient side."

Although healthcare organizations cannot single-handedly change racist societal constructs, they can create an environment where it is unambiguous that racist behavior will not be tolerated, he said. "Leadership at the top must be clear that racism is an unacceptable behavior, then they must train their staff on being able to deal with racism in the appropriate manner. There also must be training for conscious and unconscious biases among staff. Unconscious bias is a big source of racially tainted comments. Leadership can't do much about unconscious bias among patients, but they can certainly address it among staff."

Healthcare organizations can address racist comments by patients, Schabacker said. "Among patients, they may not be aware that they are making racially tainted comments, but someone in an appropriate way can address the patient and say, 'I'm not sure you meant to say that, but it was very offensive, and we ask you not to do that anymore.' That signals to the staff that they are taken seriously, which can prevent their frustration or even leaving their job."

Staff members should be able to turn to specific people in the organization when a patient or family member makes racist comments, he said.

"As difficult as it is, they should not engage with the patient. The organization should have people to notify under these circumstances, so the staff member can say, 'I was exposed to this behavior. I feel uncomfortable addressing that person. Can you speak to them?' There needs to be a safety net for staff. They need to know that they will be taken seriously. They need to know they have somebody to go to. There must be a mechanism in place to support them. The leadership and the administration must take action."

To address racist behavior by staff members, healthcare organizations should have a clear culture and rules for what is acceptable and what is not acceptable, Schabacker said.

"You need to provide training to everybody—particularly around unconscious bias. When incidents occur, they should be tackled up front. It should not be allowed to fester. A typical reaction is to say, 'They really didn't mean that.' But if there is a racist comment, it needs to be dealt with and it needs to be addressed. There should be a clear code of conduct and a rulebook that says if there is racist behavior, here is what this organization is going to do. If something happens, there is a warning, there is training, then if something happens again, there is an escalation and there are disciplinary consequences."

Related: Lack of Diversity in Healthcare Workforce has Negative Effect on Patients of Color