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, in 2019, Black adults in the United States were 30% more likely to die from heart disease 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. This unequal treatment manifests itself whenever one group is favored over others based on characteristics such as:

• Age
• Sex and gender
• Language
• National identity
• Physical ability
• Race
• Color
• Religion
• Sexual orientation
• Socioeconomic status

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 such as:

• Disability
• Education
• Ethnicity
• Marital status
• Physical appearance
• Veteran status
• Immigration status

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

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. This demonstrates that implementing standardized, data-driven practices not only improves patient outcomes, but also safeguards against unconscious, discriminatory behaviors.

In addition, including gender-affirming care in best practices and policies is essential for ensuring a culture of genuine inclusivity. By equipping healthcare providers with the necessary education to differentiate between gender and sex, you honor the ethos of patient-centered care and help prevent bias in healthcare.

Disability Discrimination

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. In an effort to address discrimination against nurses with disabilities, the American Nurses Association (ANA) created a strategic action plan called EDUCATE, outlined below:

• Encourage workplace communication about DEI, and biases that hinder inclusion of nurses with disabilities.
• Disseminate information on developing accommodations to increase accessibility.
• Understand the unique role of essential functions and establish guidelines to include nurses with disabilities.
• Create training hubs for adaptive technology and disability resources for all nurses.
• Adopt policies to support nurses with disabilities in recruitment and advancement.
• Train management and staff in strategies to integrate the social model of disability.
• Ensure the achievements of employees with disabilities are tracked and recognized.

Racial and Ethnic Discrimination

Discrimination in healthcare also leads to the underrepresentation of minority health 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 challenge, the 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 progress toward their goal of 35%. UChicago Medicine provides a successful example of how to promote diversity in healthcare by recruiting a leadership team that embodies its staff and patient populations.

Age Discrimination

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.

Additional strategies to support your staff in making conscious efforts to combat ageism include:

• Assessing Functional Ability: Encourage providers to conduct functional assessments on patients and residents to identify their capabilities and prevent harmful stereotypes, such as assuming a cognitive impairment.
• Providing Communication Training: Teach staff to facilitate inclusive discussions involving residents and patients. Healthcare workers often unknowingly sideline older adults in conversations, focusing on their families and caregivers.
• Understanding Your Patients and Residents: Advocate for your staff to learn about their patients and residents’ life stories. The better they understand the person they provide care for and what informs their health behaviors, the harder it is to hold biased views.
• Evaluating Your Culture: Review and revise your policies and training to address ageism toward residents, patients, and your healthcare team. Systemic ageism evolved over decades, so eradicating it will take time and effort.

Discrimination Based on Socioeconomic Status

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.

The following are solutions organizations can implement to support a more equitable and inclusive workplace for vital low-wage health workers:

• Prioritize safety by providing the same education and protection to all staff.

• Offer hazard pay during crises when low-wage workers place their lives at risk to support healthcare operations and patient care.

• Reassess existing pay structures and develop strategies to increase wages above the poverty line and towards a livable wage.

• Provide paid leave so workers can afford to care for themselves and their families in times of need.

• Acknowledge and appreciate their contributions by including their achievements as a part of your organization’s overall successes.

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.