SCCM Resource Library-Systemic and Structural Obstacles to Diversity in Critical Care Medicine

Video Transcription

Thank you to the Society of Critical Care Medicine Program and DEI Committee for the opportunity to present as the 51st Critical Care Committee.  I am Wendy Ricketts-Green, Professor of Surgery and Critical Care at Emory School of Medicine, and I have no disclosures.  Today I will discuss the systemic and structural obstacle to diversity in critical care medicine looking back to go forward.  What is all this talk about diversity and obstacles in critical care medicine, and why is it important to address?  I propose that the obstacle to health equity and a healthy critical care environment will require more than just ensuring diversity.  We need to move beyond to justice, equity, diversity, and inclusion, creating inclusive environments where health equity and improved outcomes is the goal.  The objectives of this talk is to define justice, race, racism, and health equity, recognize  how structural racism manifests in the practice of medicine and the delivery of health care,  acknowledge the role organizations play in structuralism, how we can create opportunities to address retention, obstructionism, isolationism in the work environment.  Let's begin with defining race. Based on the Human Genome Project of 1990-2003, we have one human race, and 99.9% of our genetic material is the same.  Race is a social construct that has previously been described as the phenotypic expression of an individual with certain characteristics.  This began by European naturalist and anthropologist marked by the publication of the book Systema  Naturae in 1735, in which the Swedish naturalist Carl Linnaeus proposed a classification of humankind into four distinct groups.  Race is not a biologic determinant, and race is not a proxy for human genetic diversity. Race is, however, a social construct that classifies humans based on phenotypes and  governs the distribution of risks and opportunities in our race consciousness.  Structuralism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks at it.  Unfairly disadvantages some and provides unfair advantages to individuals and communities. Health equity is justice in medicine where justice in medicine is the fair and equitable  distribution of health care resources, and health equity is where everyone has fair and just access and opportunity to health care resources and to be healthy.  As we look at the categories of racism, they can be divided into categories or levels of racism.  Personally mediated racism allows for personal assaults and biases and is best exemplified by prejudices and discrimination.  Internalized racism occurs when members of the stigmatized races of negative messages accept the negative statements about their own abilities and intrinsic worth.  Institutionalized or systemic racism, this is where we will focus most of our attention today, where a health system, organization, or society unfairly distributes resources  and access to power. Limited access to medical school standardized testing, school loan debt, lack of mentorship,  sponsorship, lack of promotion and advocacy, as well as lack of leadership opportunities.  Why do we emphasize this? The emphasis on structural racism, because this is one of the major obstacles to diversity,  equity, and inclusion, and focusing on structural racism is essential to advance health equity and improve population health.  The first step upon the AMA recommendation is to acknowledge the areas where an organization has contributed to structural racism and create strategic plans to address the concerns.  The AAMC is addressing and eliminating racism as created toolkits for self-reflection, being  an anti-racist, speaking out on systemic racism, and how to collaborate with diverse communities.  Nicole Franks and her research team looked at how to address these concerns from an organizational  perspective in the Emergency Medicine Society by building workforce diversity, advocating for equitable opportunities for advancement, maintaining lifelong learning in anti-racism,  and measuring and benchmarking equity in emergency medicine outcomes. And we can do the same in critical care medicine.  The first step is for us as a society to gather the data to see where we are in our organization in order to know where we want to be.  And that was just done recently and published recently. 56% of our members are male, 43% are female, and 1% specify other genders.  91% of members are straight, while 9% are gay, lesbian, bisexual, or other, and committee volunteers to these demographics.  37% of our members who provided ethnicity data, 57% selected white, 15% Asian or Pacific  Islander, 10% mixed, 18% Hispanic-Latino, 6% Middle Eastern or East Indian, and 4% African-American or Black.  28% of our members are 31 to 40, 25% are 41 to 50, and 19% are 51 to 60. The remaining 28% are divided between those older than 61 and younger than 31.  50% of our members work in an academic center or affiliated medical school, 33% work in  a community hospital or other non-governmental settings, and 7% work in a government facility. The remaining 10% work in a group or solo practice.  When SECM looked at the Congress faculty since 2015, they identified that they have become more diverse over time, particularly in regard to ethnicity.  Recent ethnicity data for faculty shows that 63% identify as white, 14% Asian or Pacific Islander, 8% Hispanic-Latino, 7% African-American Black, 7% mixed, and 1% East Indian.  Regarding gender, 53% of the faculty for Congress were male and 47% female. This data of our organization shows that we have opportunities to study the demographic  data in other areas, such as leadership, name collectors, URM collaborative research awardees, and sponsorship levels for committees, positions, etc.  We also have the opportunity to create an organizational DEI leader on the executive board. To get to the root of the problem and create opportunities for justice and health equity,  we need to address the barriers that flow in the critical care of medicine healthcare provider pipeline.  What is causing the obstructions and causing poor recruitment and retention and promotion that we do not have enough diverse talent to address the current healthcare needs?  What causes the leaky pipes in critical care of medicine? These obstacles are often due to obstructionism, isolationism, toxic work environments, as  well as anemic levels of STEM trainees and faculty in the critical care provider pipeline. These blockages may be different for everyone.  For women, the blockage may be due to glass, cotton for those who are descendants of the  enslaved, bamboo for the Asian Pacific Islanders, and concrete for our Latin brothers and sisters.  Isolationism can trigger a fight-or-flight mechanism and a strong desire to leave one's current employment surroundings.  This can occur when a colleague reports a minor concern and the response is overly punitive towards women and those from underrepresented in medicine groups, or when your colleague  has the same complication or worse and the environment is more supportive than critical for that individual, and justice is not equitable when it is your complication.  All the buttons of the imposter syndrome are pushed and you just want to get away from the caustic environment.  Imagine the pipe heating up and eventually the water will turn to steam and evaporate away, or so the afterburn is so caustic that the fumes are suffocating you and you lose  your voice, and even worse, your ability to breathe. Furthermore, a lack of promotion and advocacy leads to loss of talent.  A toxic environment makes an organization unable to attract new talented diverse members of the critical care team. What is the answer?  To acknowledge environment and leadership failings and to move forward with intentionality towards health-justice. Why should we care about the health equity and pipeline diversity?  We did not create the structural isms, but we have a role to play in dismantling it and cleaning up the mess. We can't sit on the sidelines and publish about disparate outcomes.  We need to provide solutions to the outcomes as we do with any other problem.  It is not enough to say I am not a racist, but instead be an anti-racist where you are actively standing up for truth and health equity for the ethnically diverse population.  It is not enough to recruit diverse faculty, but we must include them at the table where important decisions are being made.  Inclusion will make the organization better able to bring health justice to its surrounding communities, improve outcomes, and increase diverse revenue streams.  Remember, most social advances were made not only because of altruism, but often because there was a financial need.  Besides removing the obstructions and clogs in the pipes, we need to plug the holes where talent escapes due to isolationism.  This looks like not being included on a grant, overlooked for meaningful professional advancement,  and a lack of sponsorship both in private practice settings, academic centers, health care systems, and national societies.  We need to acknowledge the value added by those individuals who are supporting DEI efforts. We bring significant worth to the organization and should be compensated, protected time,  funding, etc. For those involved in the inclusion, diversity, equity, and anti-discrimination work, the  time spent doing the work around academic enrichment of URM students, residents, and junior faculty can be time-consuming, as well as the additional work towards retention  and excellent talented individuals. These efforts are a cost savings to the organization by increasing retention and decreasing the  expenses related to the loss of institutional knowledge and the constant hiring and onboarding which can be expensive.  As we address toxic or unwell work environments, we have to consider, can we attract talent to our critical care training program?  And have them thrive if no one who looks, talks, or has your preferred gender or sexual identity group ever or sparingly graduated from that program, nor worked as faculty,  staff, or had a leadership role in the C-suite? Has anyone in your organization had your shared experiences?  If not, why would anyone bring their talents to an organization that has toxic waste surrounding them and is not afforded? The answer is no.  This work to clean up this problem, this toxic work environment problem, cannot be left to the descendants of previously enslaved nor itinerant farmers or those who intersect based  on their gender identity. The mantle of justice must be held up by every hire, C-suite executive, and healthcare society  leader in order for us to address all the work that needs to be done. So let's get to work as toxic waste removal specialists.  We will need ongoing training and cultural humility as new treatments will be needed to address this very resistant problem.  Don't be faint at heart and take notice that Harriet Tubman, after obtaining her freedom, went back for others and led her enslaved brothers and sisters along the Underground  Railroad. True to her mission, she needed collaborators to amplify her successes. She needed those willing to fund the mission, actively speak out, and make changes through  policy and procedure. She also needed those willing to be a sponsor to open up their homes and put themselves  and their families at risk for being the change agents we so desperately needed. So we can clean up the toxic mess because racism will kill us all.  It is the right thing to do and it can benefit you individually and collectively as a community. It is called the curb effect.  As stated in her infamous words, Equity, Not a Zero-Sum Game by Angela Glover Blackwell, she published on the curb cut effect and it is as follows.  Some benefits in a society experiencing the curb cut effect. First documented as a response to the advocacy of people in wheelchairs, these sidewalk indentations  turn out to benefit many. Those pulling suitcases on wheels, pushing babies and young children in strollers, bikers, workers with large racks making deliveries, and many others.  The curb cut effect is a vibrant illustration of how laws and programs designed to benefit vulnerable groups such as the disabled or people of color often end up benefiting all.  That creation underscores a foundational belief we are one nation, we rise or fall together. Without equity, there can be neither progress nor prosperity.  The curb cut effect in its essence asserts that an investment in one group can cascade out and up and be a substantial investment in the broader well-being of our nation.  One whose policies and practices create an equitable economy, a healthy community of opportunity and just society. Thank you for the opportunity to present.

Video Summary

In this presentation, Wendy Ricketts-Green discusses the systemic and structural obstacles to diversity in critical care medicine. She emphasizes the importance of justice, equity, diversity, and inclusion in creating inclusive environments where health equity and improved outcomes are the goal. Ricketts-Green defines race as a social construct that governs the distribution of risks and opportunities, highlighting the role of structural racism in the practice of medicine and healthcare delivery. She addresses the need for organizations to acknowledge their role in perpetuating structural racism and create strategic plans to address these concerns. Ricketts-Green also emphasizes the importance of gathering data to understand the demographic makeup of organizations and take steps to increase diversity and inclusion. She discusses the barriers to diversity and retention in critical care medicine, such as obstructionism, isolationism, and toxic work environments, and emphasizes the need for intentional efforts to promote health justice and address these obstacles. Ricketts-Green concludes by highlighting the importance of collaboration and advocacy in dismantling structural racism and creating equitable healthcare systems.

Asset Subtitle

Administration, Professional Development and Education, 2022

Asset Caption

Learning Objectives: -Provide methods to recognize and address microaggressions in the workplace -Build diversity through mentorship and training -Discuss ongoing SCCM actions to address DEI issues The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2022 Critical Care Congress held from April 18-21, 2022.

Meta Tag

Content Type Presentation

Knowledge Area Administration

Knowledge Area Professional Development and Education

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Workforce

Tag Diversity Equity and Inclusion DEI

Year 2022

Keywords

diversity

critical care medicine

justice

equity

inclusion

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