Seven things organisations should be doing to combat racism

In the USA, the racial disparities in COVID-19 health outcomes collided with national conversations about racism sparked by the police killing of George Floyd. These events stimulated many organisations, including health-care institutions, to scramble to vocalise their stances on racial equity. The coming years will show if these statements translate into fundamental, lasting change. There are seven actions I hope to see from health-care organisations committed to addressing structural racism and building equitable environments.

First, organisations need to articulate specific, bold, meaningful goals that relate to actions and change, not stances, feelings, or generalisations. They should acknowledge a starting point and what progress looks like—ie, here are ways in which racism and racial inequity exist within our walls; here is what we must accomplish; and here are the steps to ensure we get there. Goals should have specificity, timelines, and ownership. They should be endpoints, not processes. Language should be clear—the goal is to address racism, not merely “culture” or “respect”.

Second, in creating goals, organisations should aim high. While efforts to advance equity must be feasible and sustainable, our default slow, “don't rock the boat” approach has achieved the current state of devastating inequity. Incremental improvements in representation, whereby expectations for “diverse” faculty begins and ends with their arrival, could, for example, be put aside for creating cultures in which all individuals can expect to thrive. Intermediate goals such as diversity are better thought of as natural by-products of higher-level efforts.

Third, goals must be linked to metrics. Organisations need to define target outcomes that accurately represent accomplishment of goals and rigorously measure them over time. Data should be both quantitative and qualitative to track progress and capture the lived experiences of health-care workers and patients. A data-driven approach will allow organisations to be systematic in their path to equity.

Fourth, organisations need to contribute to the knowledge base. Even with the best of intentions, all organisations will struggle to succeed in abolishing racism without an industry-wide investment in formal examination of anti-racist efforts. Research should not focus on gathering further evidence of already well documented inequities but should push to finding effective interventions. However, organisations need not wait for evidence to begin the process of change; rather, they should initiate theoretically based organisational innovations, and study them to inform future efforts.

Fifth, organisations must be thorough in scrubbing out inequity from every place, process, and practice. Racism is in the very physical environment of health-care settings—in portraiture, artwork, textbooks and learning modules, and equipment such as resuscitation manikins. It is present in clinical processes, including race-based diagnostic and treatment algorithms. It is signalled through decision-making processes, resource allocation, awarding of honours, and types of, and participation in, social gatherings. Racism is cross-cutting and penetrates all organisational endeavours, so the response to it must be as well.

Sixth, organisations should transform the workforce, including leadership. Racial equity in the workforce is both a mediator and a moderator of health equity. A flourishing diverse workforce provides health benefits to a diverse patient population and strengthens the equity orientation of the entire organisation. Failing to bring equity to positions of power reflects hypocrisy and insincerity and will inhibit sustained anti-racist work. Institutions need to create succession plans; resist dynastic or otherwise biased accelerators of advancement; transform recruitment and selection processes; and place term limits on leadership roles so that there is opportunity for turnover.

Finally, organisations must invest heavily in dismantling racism. Equity efforts require strong, high-level, and sustained financial investment. Investments should be long term and include a sufficient number of positions, funding to mitigate cultural taxation imposed on minoritised employees and volunteers, and evaluation, education, and training programmes. A substantial portion of the investment should be to pipeline programmes to facilitate workforce and leadership goals.

The COVID-19 pandemic has made it clear that addressing our racist societies and structures is a matter of life and death. We need to get real about reversing course on racism, and doing so will require concrete and focused action, commitment, discipline, ambition, boldness, and money.

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