During my nearly 15-year career as an ER doctor I have worked in many emergency rooms across the United States—in the Northeast, South, and Midwest. One common thread among these work experiences is the disparity between the composition of the health care workforce and the patient populations served. Inner city health care settings that serve large populations of African-American/Black and Latinx patients often have few health care providers—nurses, docs, physician's assistants, respiratory therapists, pharmacists—from these communities.
This mismatch between the U.S. health care workforce and patient community can impact both patients and providers. Patient health outcomes, communication with providers, and overall patient satisfaction improve when patients and providers share a similar background. Further, diverse work environments may positively impact health care provider job satisfaction. Increasing diversity in health care work settings is a first important step that could help to increase equity and inclusion in these environments.
Recently, I pursued a visiting fellowship at the RAND Corporation's Center to Advance Racial Equity Policy (CAREP). What I hoped to gain from this experience was an equity lens—knowledge and practical tools that could be applied both in clinical practice and research to promote diversity, equity, and inclusion.
Increasing diversity in health care work settings is a first important step that could help to increase equity and inclusion in these environments.Share on Twitter
As part of this fellowship, I applied this equity perspective in the context of a CAREP-funded project aimed at developing a framework for a pathways program to increase African-American/Black representation in the U.S. health system. Every step of this project—including all aspects of design and implementation—incorporated an equity consideration. The study team included African-American/Black health care providers. To ensure we didn't exclude relevant experiences, the project literature review included a review of grey literature, which is literature not published in a peer-reviewed journal.
The project interviews and focus groups included representation from members of the African-American/ Black community, including health care providers, youth educators, local leaders in the community/grassroots community organizations, and parents.
Four takeaways emerged from this exercise.
First, efforts toward increasing diversity, equity, and inclusion may require active engagement rather than passive agreement. Work in this space can require time and patience to build trust within the patient and provider communities involved.
Second, an acknowledgment of the history and reality of persistent systemic racism in the United States will be critical. Many of the challenges with lack of diversity, equity, and inclusion in health system settings are rooted in systemic racism.
Third, passion for advancing diversity, equity, and inclusion helps, but may not be enough. For any clinical or research effort in this area to succeed, those with deep knowledge of existing science on effective strategies and policies and/or relevant practical experience should be made part of the effort so that potential solutions are rooted in the best available evidence. Whether the goal is conducting diversity, equity, and inclusion research or improving these in clinical settings, individuals from the patient and provider community can be critical contributors.
Many of the challenges with lack of diversity, equity, and inclusion in health system settings are rooted in systemic racism.Share on Twitter
Fourth, those of us who work in the diversity, equity, and inclusion space may need to carefully consider and mitigate unintended negative consequences of strategies so that—as the medical adage goes—we “do no harm.” Even with the best of intentions, going into this work with assumptions about the community without understanding the specific group's sensitivities, priorities, and values may create distrust and inadvertently do more harm than good.
As many hospitals and health systems in the United States appoint diversity, equity, and inclusion officers and consider implementing related strategies, they should consider the best available evidence and patient and provider community input as part of the process. Without engaging experts in diversity, equity, and inclusion, and considering the experiences of patients and providers in determining a path forward, boxes may get checked, but these efforts may not result in meaningful and sustainable change. Rooting such efforts in honest and open discussions about the realities and implications of systemic racism in health care settings could lead to equitable and inclusive health care environments for all.
Mahshid Abir is a senior physician policy researcher at the nonprofit, nonpartisan RAND Corporation.
Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.