Dr Joanne Flavel, Assoc Prof Brahm Marjadi, Dr Paul Gardiner and Dr Kristen Glenister
It is well recognised that inclusivity improves health and wellbeing outcomes. However, practical tips for frontline clinicians and students can be difficult to find.
Where guidelines for inclusive practice do exist, there is often a focus on just one aspect of diversity, without sufficient (if any) consideration of intersectionality.
A culturally or linguistically diverse person, for example, may also be gender diverse, and the intersection of these identities can expose them to overlapping forms of discrimination.
Yet many practical considerations of inclusivity can be easily applied – for example, non-judgement, clear communication, and empathy.
The Diversity, Equity and Inclusion Special Interest Group (DEI SIG) of the Public Health Association of Australia includes people with lived experience and/or expertise in many aspects of diversity and their intersectionality.
These include social determinants of health, gender and/or sexuality diversity, migrant or refugee background, rurality, socio-economic disadvantage, disability, chronic ill health, children and young people, older people, and ethnic minorities.
The DEI SIG recently published a paper on inclusive practice in healthcare settings. Through a process of collaboration, discussion and deliberation, we settled on 12 tips that we expect will be useful for practitioners (Figure 1).
We want to share some scenarios and thought starters to help practitioners consider opportunities to be more inclusive.
Can you spot which of the above tip/s and underpinning concepts would help in each of the case studies below? Multiple tips may be applied in different combinations depending on your work setting.
- Imagine Carol having a checkup about a family history of heart disease and finding that there are no blood pressure cuffs that fit. How might we advocate for equipment, furniture and spaces that ensure comfort and accessibility for people with a range of different body sizes, disabilities and specific cultural practices?
- Imagine Gina, a competitive wheelchair rugby player, being told that she was ‘confined to a wheelchair’. Imagine Jo, overhearing someone in ED saying ‘be careful of the schizophrenic in curtain 2’. How would Gina and Jo feel? One may see the need for more appropriate terms here; but how often do we hear that this is ‘political correctness gone overboard’ – and how do we respond to such comment?
- Imagine health professionals assuming that Mary’s multigenerational household was difficult, inadequate or associated with some type of risk. How can we ensure that we use a strength-based approach which considers a patient’s context and appreciates their abilities and knowledge?
- Imagine how difficult it would be to find your way around a busy hospital if the signs are difficult to read because of font size or lighting. A range of people can assist with ensuring signs and symbols are clear, informative, inclusive and welcoming, but these outward signs must be matched with inclusive practices.
- Imagine Lindy, who lives with severe depression, insecure housing and poverty needing to pay hundreds of dollars out of pocket to secure an appointment six months away. Many people within the health system have a role to play in addressing access barriers including prohibitive cost, inflexible appointment hours, discrimination and fragmented care.
- Imagine meeting someone from a different background to you. How can we show commitment to ongoing learning about diversity, consideration of intersectionality, and self-reflection and check assumptions and bias?
- Imagine Mohammed, accessing a health service for the first time, but not seeing any signs of staff who look or sound like him. Ideally, staffing should reflect the patient population where appropriate, and patient voices should guide service planning.
- Imagine Rahul receiving a diagnosis of cancer and trying to understand a stream of acronyms. How might we adapt our language to the situation, meet the needs of patients and reduce power imbalance?
- Imagine Ro, who is repeatedly asked if they are pregnant or need contraception advice, despite being in a same sex marriage. How can a health service be more inclusive to Ro? The receptionist may choose inclusive pronouns. The doctor may ask some general questions. The medical record may note relevant contextual information. These may assist in avoiding unchecked assumptions and stereotypes.
- Imagine Rob, a care coordinator, advocating for an improved patient journey across multiple health and social care providers. How can we advocate for improved coordination of care, integration of services, improved eligibility criteria or streamlined referral processes to avoid duplication or gaps?
- Imagine Sefo learning that the medication he has been prescribed may have little effect, or potentially increased risk because of his ethnic background? How can we redress long standing underprepresentation of rural people, women, and culturally and linguistic diverse groups in clinical trials, in order to improve health outcomes and develop tailored evidence-based practice?
- Imagine Vu interpreting end of life care for his elderly mother. Is it appropriate for a family member to be responsible for interpreting? How can we ensure that translated material is appropriate and accurate?
Inclusive practice in healthcare settings requires ongoing conversations. Diversity is in constant state of flux, as are levels of societal awareness and accepted language regarding diversity.
The use of a strength-based approach in inclusive practice is particularly advantageous as the context in which patients navigate their healthcare journeys can be more fully considered.
In public health in particular, a strength-based approach is ideal as it turns the focus to protective factors and those that promote health and wellbeing.
It is our hope that these 12 tips will provide practical guidance for frontline clinicians and spark valuable reflection and discussion for the benefit of all.