Addressing Institutional Racism In Healthcare Organizations

Addressing Institutional Racism In Healthcare Organizationsfive Stra

Addressing Institutional Racism in Healthcare Organizations: Five strategies for health system leaders. After George Floyd died while in the custody of the Minneapolis police, Americans (and many others from around the world) marched in protest against this killing that exemplified the historical violence experienced by people of color and the systemic racism that many believe led to this tragedy. For many reasons, including the inequitable toll of the coronavirus pandemic and its economic consequences on people of color, George Floyd’s death is the latest of many similar tragedies that have galvanized millions of Americans to understand the connections between the systemic racism of the criminal justice system and systemic racism in other sectors of society such as housing, education, and healthcare.

In solidarity with the movement against the oppression of Black lives, industry leaders, including health system CEOs, made solemn public commitments to address structural racism in their organizations. We cannot lose the momentum of this moment. But how do we begin to address institutional racism in healthcare organizations? In 2017, the Institute for Healthcare Improvement (IHI) used its framework for achieving health equity—"Achieving Health Equity: A Guide for Health Care Organizations"—which includes a component focused on institutional racism, to guide the work of health systems participating in the Pursuing Equity initiative. Based on learning from this initiative and further IHI research published in 2019, this article presents strategies in five core areas to guide healthcare leaders as they seek to address institutional racism in their organizations.

Such efforts involve a commitment to change structures, processes, and norms to bring about equitable outcomes in healthcare. They also aim to engage the hearts and minds of all who work in the organization to challenge preconceived notions about race and privilege, as well as to learn about the history of racism in the U.S. and the organization’s history in the community.

Understand History

An initial step is to learn the history of racism in the U.S. and how it manifested in the city or town where the institution is located and within the organization itself. Are there examples analogous to the Tuskegee syphilis experiment on Black Americans or to the experience of Henrietta Lacks, whose tissue sample was taken and used for profit without her knowledge? Has the organization participated in gentrification, and did the institution have a reputation of not being a welcoming place for people of all races? Who could practice medicine at the organization? Speaking with community members can help uncover whether the organization has a racist legacy. These stories are passed down through generations and contribute to mistrust of healthcare today. Recognizing the history also involves understanding the struggles faced by people of color in the community and acknowledging the advantages that white people have benefited from because of structural racism. When leaders and staff engage in their own personal journeys, they contribute to a better understanding of how the past influences present actions. Each individual brings their own story and history to their role in healthcare, and personal reflection is critical to advancing racial equity.

Establish a Welcoming Culture

Creating a welcoming organizational culture involves several strategies. Firstly, fostering open conversations about race and racism and how these issues influence current practices. Secondly, changing systems and processes that perpetuate health disparities and being willing to engage in uncomfortable conversations to address these issues. Thirdly, educating staff and clinicians about implicit bias and evidence-based methods to counteract it. Fourthly, listening to and responding to the needs, norms, and preferences of the community is essential when shaping organizational culture. Lastly, the physical environment—such as décor, color schemes, and visual displays—should reflect the rich diversity and cultures of the populations served, contributing to an inclusive atmosphere.

Commit to a Diverse Workforce

A diverse workforce is vital for addressing institutional racism. Healthcare organizations should ensure hiring practices attract diverse applicants and implement retention strategies such as professional development, mentoring, and promotion opportunities for staff of color. Demonstrating commitment to diversity from the top leadership—board members, executives, and clinical staff—helps reinforce organizational values. When staff and leadership reflect the racial and ethnic makeup of the community, decision-making becomes more sensitive to the needs of historically underrepresented groups. Additional efforts include addressing employment criteria that exclude low-income individuals, offering certifications and training during employment, responding meaningfully to reports of discrimination, implementing fair performance evaluation procedures, ensuring equitable pay, and analyzing demographic disparities in disciplinary actions and benefit utilization to foster an equitable work environment.

Assess Business Practices

Beyond workforce issues, it is important to evaluate business practices through a racial equity lens. This includes reviewing insurance acceptance policies, site selection for new facilities, and conducting Racial Equity Impact Assessments to gauge how policies affect underrepresented communities. Strategies used by anchor institutions—such as local procurement, job training programs, community investment, and inclusive hiring—can help promote equity. Building community health and wealth through strategic investments and partnerships, leveraging philanthropy to support underserved populations, and localizing economic activities all contribute to addressing systemic inequities in healthcare access and quality.

Examine Clinical Operations

Addressing disparities within clinical operations requires identifying where gaps in care exist. Stratifying quality data by race, ethnicity, language, socioeconomic status, and gender identity allows organizations to monitor and address inequities. Integrating equity into quality improvement initiatives ensures all patients, including marginalized populations, receive equitable care. Solutions aimed at populations at the margins—those with limited access or facing discrimination—often benefit the entire system, leading to better overall healthcare outcomes. Advocacy at all levels—federal, state, and local—is necessary to change policies and payment systems that hinder equitable access to care. By actively working to eliminate barriers, healthcare leaders can ensure that care is available and effective for everyone, regardless of background or economic status.

Conclusion

Efforts to dismantle institutional racism in healthcare are urgent and ongoing. Leaders must commit to understanding historical contexts, cultivating inclusive cultures, fostering workforce diversity, reforming business practices, and improving clinical operations. These strategies require sustained commitment, transparency, and community engagement. Addressing structural inequities not only improves health outcomes for marginalized populations but also advances the fundamental goal of healthcare equity—to provide high-quality care to all. As societal consciousness around racial injustice deepens, healthcare organizations must join the movement by implementing these strategic actions now. Only through continuous reflection, dedicated action, and systemic change can true health equity be achieved, benefitting individuals and communities alike.

References

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