In the latest installment of the Pathways to Action Subcommittee Spotlight Series, members of Connecticut Children’s Office for Community Child Health reflect on their participation in an anti-racism training organized by the HOPE (Healthy Outcomes from Positive Experiences) National Resource Center during the 2024 Week of HOPE. This initiative, facilitated by the Office Culture Subcommittee, is aligned with our DEI organizational strategy’s aspiration to create a workplace where everyone feels respected, has a sense of belonging, and is empowered to contribute to our mission to improve health outcomes for children and families in our community.
In pediatric healthcare, achieving equity and inclusion is crucial.
Allison Stephens, MEd, PhD, of the HOPE National Resource Center recently led a session that emphasized the importance of anti-racism training in children's hospitals. This blog offers insights from Dr. Stephens’ presentation, which explored the concept of racism, its manifestations in healthcare settings, and strategies for actively practicing and embedding anti-racism in these environments.
Confronting Structural Racism
At the core of our efforts to foster an equitable culture is the acknowledgment of race as a social construct with profound implications for healthcare. Dr. Stephens detailed how societal constructs influence our understanding of race—from historical roots to contemporary biases. Discrimination, whether explicit or implicit, pervades interactions and institutional frameworks. Implicit biases, shaped by experiences and societal norms, impact subconscious decision-making, while explicit biases are overt and conscious. Both forms contribute to systemic injustices that perpetuate racial disparities.
In healthcare, we grapple with both individual and structural racism. Individual racism involves personal prejudices and discriminatory behaviors among healthcare providers, significantly affecting patient care quality. Structural racism is ingrained in policies and practices that contribute to disparities in health outcomes for marginalized racial and ethnic groups, such as the under-treatment of Black individuals for pain and their underrepresentation in medical research. Addressing these issues through anti-racism entails actively identifying and opposing racist policies, behaviors, and beliefs to ensure equitable healthcare access for all children.
Action-Oriented Anti-Racism in Healthcare
Becoming anti-racist requires proactive engagement and ongoing self-reflection. It necessitates leadership commitment, policy evaluation, staff training, and continuous data collection to drive meaningful change.
During the training, Dr. Stephens advocated for a holistic approach rooted in empathy and understanding, emphasizing active listening and responsiveness to lived experiences. She highlighted tools like family journey mapping and empathy mapping to gain insights into individual experiences, facilitating a nuanced understanding essential for dismantling systemic barriers.
This training aligns with our efforts to address patient healthcare inequities by tackling both individual and structural racism within our healthcare system. Structural racism, deeply embedded in policies and practices, contributes to disparities in health outcomes for marginalized racial and ethnic groups. Dr. Stephens’ session emphasized the need to actively identify and oppose these inequities, ensuring that every child receives equitable access to quality healthcare. This aligns with our strategy to reduce and prevent health disparities through targeted education and evidence-based practices.
Family Journey Mapping
Family journey mapping visualizes the entire healthcare experience of families, charting each interaction from initial contact to follow-up care. By visually mapping out these touchpoints, healthcare providers can pinpoint critical moments where families may encounter challenges or barriers.
For example, family journey mapping may reveal that non-English-speaking families struggle with medical instructions due to inadequate translation services. Recognizing these pain points enables healthcare institutions to implement targeted interventions, such as hiring bilingual staff or providing translated materials, to enhance overall experiences and outcomes for these families. Family journey mapping has been utilized to improve the experiences of families of children with autism as they navigate multiple systems, and has been applied to pediatric palliative care, leading to the creation of an online journey map tool for families of children with severe neurological impairments. Journey mapping centers the patient/family experience, fosters empathy through shared learning and can ultimately improve both patient satisfaction and patient safety.
Empathy Mapping
Empathy mapping delves deeper into the emotional and psychological aspects of patients’ and families’ experiences. This tool helps healthcare providers understand the thoughts, emotions, and perceptions of patients and families at different stages of their healthcare journey.
An empathy map typically considers four quadrants:
- Thinking: What are the patient's or family's concerns, hopes, and expectations?
- Feeling: What emotions are they experiencing? Are they anxious, hopeful, confused, or relieved?
- Hearing: What are they hearing from doctors, nurses, or other families? Are they receiving clear, consistent information?
- Seeing: What are they observing in the healthcare environment? Is it welcoming and inclusive?
By employing empathy maps, healthcare providers can develop a deeper understanding of patient experiences, leading to more compassionate and effective care. For instance, if empathy mapping reveals that patients struggle with complex medical terminology, healthcare teams can adjust communication strategies to improve comprehension and comfort. These tools enable us to implement targeted interventions that enhance overall patient experiences and reinforce our commitment to community-centered care.
Our DEI strategy’s Community Action Pillar focuses on collaborating with community partners to enhance health and well-being. The tools highlighted in this is anti-racism training, family journey mapping and empathy mapping, can be utilized to better understand and address the unique challenges faced by families from diverse backgrounds. Family journey mapping helps identify critical moments where families may encounter barriers, while empathy mapping provides insights into their emotional and psychological experiences.
Continuous Improvement and Community Engagement
Sustained efforts in continuous quality improvement are crucial. The HOPE framework offers a comprehensive approach to continual improvement, guiding healthcare leaders in using data to identify disparities, engaging with affected communities to understand their perspectives and priorities, and implementing policy changes that directly address these disparities by enhancing community access to needed support and resources.
One effective strategy to apply this continual improvement lens to anti-racism efforts is through SMARTIE goals. These goals extend the traditional SMART framework (Specific, Measurable, Achievable, Relevant, Time-Based) to include Inclusive and Equitable considerations, thus bringing traditionally marginalized communities (especially the most impacted) directly into the decision-making process for more equitable power sharing, and incorporating an intentional commitment to justice to address systemic inequities.
Our DEI strategy focus on Workplace and Workforce highlights the need to cultivate a culture where every team member feels engaged and supported. This anti-racism training is a crucial component of that effort. By enhancing knowledge and skills around anti-racism, the training aligns with our DEI strategy's Education and Awareness objectives, turning awareness into practical allyship. This approach advances our goal of building a respectful and inclusive environment where all staff members are empowered to promote equity in healthcare.
Closing Reflections
Dr. Stephen’s session underscored the necessity of embracing anti-racism to deliver equitable care and combat both individual and structural racism in healthcare settings. The family journey mapping and empathy mapping tools provide insights into systemic barriers and improve patient experiences, while the SMARTIE goals framework builds anti-racism into continuous quality improvement. It is the hope of the Equity Committee that Connecticut Children’s team members will consider utilizing these tools in their work, and/or signing up for additional anti-racism training from the HOPE Network, to learn more. Anti-racism ensures that every child, regardless of race, receives equitable access to quality healthcare, fulfilling our ethical obligation to promote justice and inclusion. By adopting frameworks like SMARTIE goals and the HOPE continual improvement approach, we can eliminate disparities and create a more inclusive environment. Let’s commit to advancing equity in children's hospitals and beyond, ensuring that all children receive medically excellent and culturally responsive care.
The anti-racism training that inspired this blog was developed by the HOPE National Resource Team in partnership with Strengthening Families and members of the Family and Community Experts of HOPE Council. It was aired on March 18, 2024, during the 2024 Week of HOPE.