Call for action: engaging pain practitioners and other health care teams in anti-racism

To the Editor,

Racial inequities are increasingly recognized as an important determinant of health and wellness, and a priority for health care professionals. Awareness of personal bias and structural barriers to equity, diversity, and inclusion (EDI) is slowly increasing in health care, with medical schools examining admission standards to increase diversity and physicians calling for anti-racism to be included in professional standards.^1–3 Research and development of active mechanisms to address racism in hospitals and in anesthesiology is sparse. Outside of discussion of racism and its impact on health care, and journal calls for EDI-related articles (e.g., this month’s Special Issue of the Journal on Equity in Anesthesiology and Critical Care), there remains a paucity of active attempts to drive change in and for health care workers. Furthermore, Black health care providers (among other racialized groups) experience lack of support or mentorship from colleagues, and both subtle and overt racism from colleagues and patients.⁴ We developed a workshop to address some inequities experienced by racialized patients and pain specialists (including anesthesiologists), facilitate open dialogue, and contribute to promoting the importance of dismantling systemic racism within a pediatric hospital.

We introduced concepts relevant to racism and its impact in pain services and outpatient therapy (Electronic Supplementary Material [ESM] eAppendix 1) and provided suggestions for recognizing and countering it (ESM eAppendix 2) within an easily delivered, one-hour format. We sought to counter behaviours that stem from factually incorrect and discriminatory beliefs that persist in health care. The workshop was delivered virtually (because of COVID-19 restrictions) to five small convenience sample groups. Participants were grouped by clinical specialty (e.g., interdisciplinary chronic pain, rehabilitation therapy; ESM eAppendix 3), so that members would be familiar with each other. The facilitators were intentionally women of colour and a White woman or man to provide a range of facilitators and increase connection with the audience. This approach models the importance of all races being involved in dismantling racism. Furthermore, only 28% of our participants identified as “part of a marginalized group.” We wished to avoid implying that anti-racism work lies solely with those who are negatively affected by racism; rather, it also includes those who may benefit from racism.

Using REDCap® electronic data capture tools1 hosted at the Hospital for Sick Children (Toronto, ON, Canada), we administered a Quality Improvement Board-approved pre–post survey of attitudes and knowledge at baseline and immediately after the workshop and of strategies one month following the workshop. Using five-point Likert scales, clinicians ranked their awareness of anti-racism knowledge and/or action before and after the workshop, and the workshop’s acceptability (Figure).

Figure.

Awareness and action following anti-racism workshop: results of participant surveys

Our anti-racism workshop improved participants’ self-reported knowledge on anti-racism, reduction of bias, and understanding of the influence of bias on the delivery of care (ESM eAppendix 4). One-month retention of self-directed learning and peer-to-peer education strategies to combat racism was low (ESM eAppendix 5). Repeated workshops and efforts are effective in reinforcing behaviours⁵ and in building the confidence required for active engagement in anti-racist actions. There is an opportunity for engagement at all levels, including leadership and all workers. To truly dismantle racism in health care settings, everyone must be involved. The structural changes in government, societal interactions, and removal of barriers to racialized people require sweeping change well outside the scope of a single health care institution. Nevertheless, by tackling elements of anti-racist practice, we engaged with health care providers to educate and support daily efforts towards anti-racism. Such efforts cannot occur in isolation and must be adjuncts to an intentional, institutionally supported strategy to combat racism in health care and in the workplace. We suggest other anesthesia groups can lead the necessary changes within their institutional culture and, as such, have a lasting impact over years to come. This work must avoid simply accomplishing checkbox metrics like offering an EDI course, recording numbers of racialized employees, or bringing in a guest speaker as measures of success. It requires repetitive, studied, and knowledgeable attention to truly induce change.

Electronic supplementary material

Below is the link to the electronic supplementary material.