7 July 2022

The first instalment of a new extension to our Bulletin ‘In the Journals’ focuses broadly on evidence around bias in healthcare professionals.

A new feature

The aim of this new feature is to enhance the carry over of research into practice, and of knowledge exchange. It highlights recent research in key areas of relevance to anti-racism, equality, diversity and inclusion in the health professions and among service users, and offers short commentary pulling the themes together, as well as some thoughts on the potential implications.

Within the feature, we will introduce three recent publications. The articles have been recommended or flagged to us by members or staff, as ones likely to be ‘of interest’ to RCSLT members, as well being recent publications from specific topical journals.

The content of the research articles will be summarised but will not offer a critical appraisal of the article. We encourage members to always cast a critical eye on information they read and interpret findings and conclusions to an appropriate degree, based on the specifics of the study itself.

If you would like to be involved in developing the next instalment, by either suggesting an article or writing a summary yourself, please email katie.chadd@rcslt.org.

Undoing racism and mitigating bias

This systematic review explores the literature on the topic of post-registration training on anti-racism for healthcare professionals. It aimed to identify the goals and outcomes of any such training.

A search of literature published in the five years prior to the study, across three databases, yielded 1,404 articles of interest. Following screening and quality assessment, 11 of these were carried forward for review.

A range of healthcare professionals were represented in the studies. Four had a sample of ‘multiple disciplines’, two sampled nurses, and five focused on physicians. The content of training also varied – the most common themes were ‘racism or discrimination’ and ‘clinician/client interaction’. Many studies did not fully describe the content of the training. Measures of impact were only included in five studies. Of these, outcome measures varied but four of the five included a measure of ‘awareness’.

The review concludes there is a significant gap in the evidence base for anti-racism training for healthcare professionals. Even within the studies that are published, there is an absence of detail about what the training entailed, and what the impact of the training was.

The authors suggest: “the fostering of cultural humility within healthcare workers is imperative for the realization of a cultural shift away from implicit bias and toward an anti-racist approach to health care”.

Perspectives on racism in healthcare

This qualitative systematic review aimed to bring together findings from studies exploring perspectives of both health professionals and patients on racism in the healthcare system, intending to problem-solve the consequential issue of health disparities.

A literature search of five databases was conducted. The initial search yielded 4,018 articles. After screening and quality assessment, 23 articles met the inclusion criteria and included in the review.

Three overarching themes were identified in the review. ‘Alienation of minority patients’ was characterised by the sub-themes ‘racial supremacism’ and ‘less empathetic care received’, broadly describing belittling attitudes thus lack of care from professionals to patients. The theme ‘labelling of minority patients’ referred to ‘assumptions of class’ and ‘assumptions of negative behaviours’, which highlighted the negative stereotypes that professionals often held, which manifested as a lack of person-centred care. The third theme, ‘perpetuation of racial fault lines by providers’ captured the sub-themes ‘differential treatment of minority patients’ and ‘shifting the blame onto minority patients’. This largely described how racial biases of professionals result in healthcare failures and the placement of blame within this.

The findings highlight the multiple perceptions of how racial biases manifest in healthcare, and these were consistent across studies.

The authors declare: “To protect the fundamental right to quality healthcare for all, healthcare institutions need to urgently establish targeted anti-racism programs.”

Making race visible

This article describes a critical discourse analysis of the American Speech-Language-Hearing Association (ASHA) standards, to specifically explore whether the experiences of people of colour (students and clinicians) were reflected in these and how this is associated with racism in the profession.

The discourse of focus was characterised as “the ideal [speech-language pathologist] SLP and audiologist considers and/or fails to consider the experiences and needs of students and clinicians who are racially minoritized” (p 583).

Data included two key documents in which clinicians in the US must adhere to. Inductive analysis identified major and sub themes by both individual analysis and a group discussion. The authors also looked at literature and practises beyond SLP that resonated with the identified themes, and appraised specific elements of the documents such as vocabulary that was particularly pertinent to the focus.

Five themes were identified. The most significant theme was ‘An absence of the acknowledgement of racism’. This highlighted the rarity of reference to ‘race’ in the documentation and the absolute absence of the term ‘racism’. Other themes were: ‘the use of ambiguous language to describe desired outcomes’; ‘shifting responsibility to local programs’; unwarranted assumption of program and instructor expertise’ and ‘the homogenisation of student experiences’.

The authors end the article with recommendations for the US SLP profession, including: “to begin the work of inclusive decision-making by adapting strategies that are equity focused… One example is the use of racial equity impact assessments… Another example is the adoption of institution-wide resolutions and policies”.

Commentary

This selection of articles has highlighted the persistent and prevalent issues around systemic racism in healthcare practices broadly, and speech and language therapy specifically, within the given contexts.

While much of this evidence is from outside the UK, there are some important lessons for us to learn. Both systematic reviews highlight the absence of detailed evidence around what is involved in anti-racism training for healthcare professions, signalling the urgent need for greater clarity on this.

The final piece, examining the ASHA standards for SLPs exemplify this need, and highlights how not acknowledging racism (or, as the article discusses, operating under ‘colour-blind racism’) in healthcare creates challenges and barriers for professionals and students of colour. In the qualitative systematic review, we also see the challenges and barriers systemic racism puts upon patients of colour.

Implications

Practitioners, including SLTs, and other bodies need to be aware of the potential for unconscious bias and unchecked racism in their practice and policy. It would be highly valuable for future anti-racism training or education initiatives in healthcare more broadly, or speech and language therapy more specifically, to be fully described and evaluated.

Critical appraisal and careful evaluation of professional training materials and standards (both pre-and post-registration) would be a valuable exercise to reflect on where changes can be made that ensure the profession is acknowledging issues of racism and avoids alienating professionals of colour.

Related content

Diversity, inclusion and anti-racism hub

Information, resources and guidance

RCSLT journals collection

RCSLT members can log in to access a range of journal titles

RCSLT welcomes new report on ethnic inequalities in healthcare

Our response to the report commissioned by the NHS Race and Health Observatory