Challenging group think is vital to the effective running of an organisation. In the realm of healthcare, where lives hang in the balance every day, it can help prevent serious harm, and even death.
People at all levels in the workplace need to be able to speak up freely and have their voices heard. This is not always easy, especially when speaking up can have profound consequences for a career. But it is crucial if we are ever to uncover our blind spots and dismantle the insidious nature of systemic bias within organisations.
Overcoming barriers to accountability
Systemic bias is the tendency for procedures and practices within an institution to result in certain social groups being advantaged or favoured over others – for example, those of a particular race or gender – being disadvantaged or devalued. Individuals speaking up within such institutions involves them advocating for more equitable and inclusive healthcare practices and processes, whereas leaders receiving the speaking-up concern must take action to eliminate such biases to ensure fairness and accessibility of healthcare for all.
Systemic bias within organisations makes them less effective and increases the likelihood of harm. In settings like health and social care, where the priority is delivering safe, high-quality care, systemic bias militates against crucial patient safety 'must-haves' including transparency and openness and a culture of listening and acting when colleagues speak up. To foster a fairer and more equitable organisation, it is crucial to understand why individuals are often blind to information that challenges deeply ingrained perspectives and ways of thinking. Recognising this cognitive resistance is the first step towards meaningful change.
When it has been recognised, how do we begin to address our biases? Earlier this year, Socially Inspired conducted a diagnostic assessment of the feasibility and appropriateness of a Freedom to Speak Up (FTSU) service model within primary care for a London integrated care system. It found that patterns of systemic bias can be unearthed and dismantled where organisations foster open and safe cultures alongside stringent accountability measures. The report advocated a two-pronged approach for a harmonious balance: establishing a safe FTSU service alongside measures to ensure accountability and consistency across the wider primary care system.
Understanding and addressing systemic bias, which feeds the injustice experienced by ethnic minority individuals, is one significant facet of a broader issue. It offers us an opportunity to also challenge inequalities of power that underpin systemic bias in all its forms, encompassing protected and non-protected characteristics.
How to make progress towards eradicating systemic bias
- Recognise that it is our responsibility, as individuals and as a community, to confront and rectify injustice by acknowledging that systemic bias exists, not just in our policies and practices, but within ourselves.
- Honest communication is key. Where patients are harmed or at risk and staff are discouraged from speaking up, there will always be a sense of betrayal. We must meet this feeling, however uncomfortable it may be, creating a safe environment – and finding the language – to communicate what failures in care mean for us as a healthcare community. This is critical to process the collective trauma of these events and build a more resilient NHS.
- We need to cultivate the kind of self-awareness that can reveal what is going on in the mind when we see difference: of power or status; culture or colour of skin; gender or age. We need to develop the wisdom that enables us to recognise our assumptions and the time to question them. This introspective work is not easy, but it is essential.
- Apply your learning to your organisational processes. Once we have connected fully and honestly with the profound implications of the impact of systemic bias, we must turn our attention outward. We must have policies that promote equity and empower those who speak up, to ensure that their voices are heard, and their concerns addressed. We must build an NHS culture where speaking up is not a courageous act but an expected one, and where accountability rather than blame is not a distant ideal but a concrete reality.
Freedom to speak up within organisations allows employees to voice concerns and suggestions, paving the way for transformative shifts. However, this single voice must be in concert with an organisation's commitment to listen and act, to bring about meaningful change.
The power to effect change
As a healthcare community, we possess huge power to effect change, but with that power comes an even greater responsibility. We have a duty to protect patients and to uphold our responsibilities to protect human rights under the Nolan principles and The NHS Constitution. We must understand that it is not just an obligation to our patients and staff but to our own integrity as leaders, to take action.
In the end, addressing systemic bias in healthcare is not just a matter of ethics, it is a matter of life and death. Every moment we delay, every instance of discrimination that goes unchecked, has the potential to harm people. We have the power to change this. We have the power to create a healthcare system that truly values every life, regardless of race, ethnicity, or gender.
It is up to all of us to do both the introspective and practical work that is needed, and to ensure that healthcare remains a beacon of hope and healing for all. Our actions today will determine whether lives are saved or lost tomorrow. The choice is ours to make.
With special thanks to Mark Leonard, curator of Mindfulness-Based Organisational Education.
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