How to Address Discrimination in Healthcare: Facility Guide

Despite the existence of federal anti-discrimination laws, the problem of discrimination in healthcare continues to affect patients and staff. As a healthcare leader, attempting to combat discrimination within your organization may seem futile without a complex, multipronged strategy. Fortunately, meaningful change is achievable with simple, yet focused, solutions.

For instance, Black adults in the U.S. were 30% more likely to die from heart disease in 2019 than their White counterparts. However, researchers found that increasing Black doctors’ participation in the preventative care of Black males could reduce their cardiovascular mortality gap by 19%. The fact that 12.1% of the general population is Black, but only 5.7 % of U.S. doctors are Black demonstrates why diversity in healthcare is so important — not only can it reduce health disparities, it can save lives.

If you’re a healthcare leader looking for support in fostering a safe, respectful, and inclusive environment, we’re here to help. In this guide, you’ll learn more about how discrimination impacts healthcare and strategies you can use to address it.

Understanding Discrimination in Healthcare

Having a shared vocabulary of terms can help individuals better understand discrimination and prevent misunderstandings. The University of Washington has provided several definitions to facilitate transparent conversations. Here’s a look at a few of them.

Discrimination

There are more specific legal definitions of unlawful discrimination, but generally, this refers to the unequal treatment of individuals of various groups based on conscious or unconscious prejudice.

Diversity

This refers to the wide range of identities, ideas, perspectives, and values within an organization. These social identities include the same categories as discrimination in addition to others.

Equity

This refers to the fair treatment, equal access, and advancement for all individuals and the identification and removal of barriers that prevent the full participation of certain groups.

Inclusion

This refers to the creation of an environment that welcomes, respects, and values all individuals or groups as fully participating members.

Implicit Bias

Also known as unconscious or hidden bias, this refers to the negative associations people unknowingly have and express naturally, which affects their understanding, actions, and decisions.

Microaggressions

This refers to how the implicit biases that individuals hold can subtly, and sometimes unintentionally, communicate discriminatory intentions or behaviors towards individuals.

Macroaggressions

This refers to larger, more systemic ways that organizations or communities oppress marginalized groups beyond interpersonal biases.

The Impact of Discrimination in the Healthcare Environment

Discrimination in healthcare settings impacts patients — hindering their access to quality care and endangering their well-being. It can result in unequal treatment, delays in health services, and poor outcomes. Discrimination jeopardizes the trust between patients and healthcare providers, resulting in decreased patient satisfaction and less-than-ideal adherence to medical advice and follow-up.

Discrimination can also be a significant issue on the provider side, negatively affecting staff morale and well-being. In a survey of over 5,600 nurses, more than 50% of respondents experienced discrimination or acts of racism from a manager/supervisor.

When care workers face discrimination based on their identity, it can create a hostile work environment, lower job satisfaction, and create negative health consequences, such as increasing stress levels and hypertension. It can also make it more difficult to recruit and retain highly qualified staff.

Examples of Discrimination in Healthcare and Ways to Address It

Discrimination comes in different forms within healthcare. While this isn’t an all-encompassing list, here are some examples to demonstrate the challenges that have stemmed from bias in healthcare, with steps that leaders have taken in response.

Gender and Sex Discrimination: Examples and Considerations

In 2007, The Johns Hopkins Hospital conducted a pilot study to enhance suboptimal deep vein thrombosis (DVT) prevention practices. Researchers aimed to reduce preventable blood clots and pulmonary embolisms by improving provider compliance in prescribing appropriate DVT prophylaxis. The study incorporated a mandatory evidence-based checklist into the Electronic Health Record (EHR) system, prompting providers to order the treatment.

The successful study incidentally revealed and corrected a gender disparity where male patients were prescribed DVT prophylaxis more than female patients. The checklist improved DVT prevention in female patients from 55% to 88% — significantly reducing their risk of harm and death.

Suggestions:

• Implement standardized order protocols and clinical care flowsheets for common diagnoses and conditions to ensure fair clinical care while adjusting as needed for the individual.
• Include gender-affirming care in best practices and equip healthcare providers with the necessary education to differentiate between gender and sex to honor the ethos of patient-centered care and help prevent bias in healthcare.

Disability Discrimination: Examples and Considerations

Healthcare workers with disabilities also face discrimination in healthcare. For example, research has shown that nurses with disabilities often report that they are primarily judged on their disability rather than their abilities, prompting many to leave the profession.

Suggestions:

• Adopt the American Nurses Association (ANA) strategic action plan called EDUCATE to inform policies and strategies for improving working conditions for nurses with disabilities.
• Utilize evidence-based hiring practices to avoid bias during the hiring process, encouraging the diversity of employees and perspectives in the workplace.

Racial and Ethnic Discrimination: Examples and Considerations

Discrimination in healthcare also leads to the underrepresentation of minority healthcare professionals, which undermines an inclusive work environment and erodes cultural competency. For example, as of 2019, Black, Indigenous, (and) People of Color (BIPOC) comprised 39% of the U.S. population. However, they held only 19% of hospital board positions and 16% of executive leadership positions.

In response to this disparity, University of Chicago Medicine revamped its recruitment practices, particularly for leadership positions. They hired two recruitment firms known for successfully placing diverse candidates. In their first year, the academic health system increased its representation of BIPOC in senior leadership positions from 22% to 23%, making modest progress toward their goal of 35%.

Suggestions:

• Revamp hiring strategies by reviewing job descriptions for inclusive language and consider allying with organizations like historically Black colleges and universities to encourage recruitment.
• Insist on a culture of belonging and offer resources such as mentoring that incorporate diversity initiatives and sensitivity into partnering criteria.

Age Discrimination: Examples and Considerations

Older adults also experience discrimination in healthcare due to prejudices based on age. This can lead to undertreatment, neglect, or inadequate support for their unique healthcare needs. There is also an economic cost to ageism. The misalignment of resources and the resulting impact on patient care has been estimated to cost the healthcare system up to $63 billion per year.

To illustrate the issue, one UCI Health specialist in geriatric medicine described how an older woman’s primary care provider (PCP) dismissed her concerns due to age. After changing physicians, an interview revealed the patient suffered from anxiety and depression, and was also the victim of spousal abuse. By gathering an accurate medical history — and asking the right questions — the new PCP was able to prescribe appropriate treatment and refer the woman to a psychologist.

Suggestions:

• Onboard or partner with a geriatric mental health specialist or psychiatrist to better target the specific needs of this distinct patient population. Also, consider reaching out to local ombudsman programs to facilitate their services as advocates for the elderly.
• Invest in training around communication strategies for improving the rapport and efficacy of communication with elderly patients. This should be coupled with information about the harmfulness of stereotypes and ageist behaviors and actions.

Discrimination Based on Socioeconomic Status: Examples and Considerations

Despite being declared “essential,” low-wage health workers often feel overlooked, deprioritized, and expendable in the healthcare environment. For example, nursing assistants, housekeeping aides, maintenance workers, and others receive less recognition for their contributions compared to physicians and nurses.

To mitigate the impacts of this problem (such as the CNA shortage), it’s vital that healthcare facilities support a more equitable and inclusive workplace for all health workers, no matter their earning potential.

Suggestions:

• Prioritize a scheduling system that works for all members of the team, giving equal opportunity for preferred scheduling and days off.
• Impress a culture of teamwork and be the driver for inclusion. This may include spearheading initiatives for interprofessional collaboration, facilitating committees that work to recognize the efforts of the entire team, or hiring a chief wellness officer or to help improve the work environment throughout the organization.

Want to Learn More Ways to Address Discrimination in Healthcare?

Now that you’ve gained more insight into healthcare discrimination and DEI, you may be looking for even more ways to ensure that your patients receive equitable care and your staff members flourish. Don’t miss out on our latest updates on ways to foster a supportive and inclusive healthcare environment.