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Five Things You Can Do Today to Make Your Practice More Inclusive

Most of us agree that a workplace should be a welcoming place. But the process of taking stock and implementing real change can sometimes feel overwhelming. Where does one even start? The good news is that unconscious biases that contribute to inequities in the workplace can be interrupted. Here are some essential tips for taking your best intentions toward diversity and inclusion and putting them “into practice” in your practice. By Harriet W. Hopf, MD, FUHM, FASA

“Diversity is being invited to the party. Inclusion is being asked to dance.” -Vernā Myers

Given the powerful evidence of benefit, why are diverse workplaces not the norm? Why is diversity so elusive? While most aspire to diversity, the reality is that, without the hard work of changing the culture and creating a welcoming environment, diversity efforts are doomed to failure

Diversity is fairly well understood, and encompasses a broad range of characteristics, such as gender, race/ethnicity, sexuality, physical and mental ability, thinking styles, socioeconomic background, and national origin. It is generally addressed through recruitment. The major obstacle to diversity is unconscious bias: individuals have preferences for objects and people at a subconscious level that unintentionally influence their behavior and decision making.  

“Don’t tolerate me as different. Accept me as part of the spectrum of normalcy.”  -Ann Northrop

But what does inclusion mean? Inclusion requires creating an environment where diverse perspectives are valued and individuals feel welcome and are not pressured to “fit in.” Discrimination, unconscious bias, sexual harassment, and microinequities (verbal, behavioral, and environmental messages, often unintentional or well-intentioned, based on group membership, that are experienced as hostile, derogatory, or negative) all contribute to a work environment that is not inclusive. Recruited individuals who do not feel welcome are more likely to leave.


“Neighbor, I have bias, and I am a good person.” -Vernā Myers


The good news is that bias can be interrupted. The first step is to be aware of your biases. The Implicit Association Test is a good starting point. The next step is to listen. If someone points out bias or a micro-inequity: stop, acknowledge and be curious about their experience, and adjust your behavior. Refute and reframe to reset your bias: think of a person from an underrepresented group who is a successful leader and use that image to replace the biased image. Slow down: time pressure increases reliance on bias, while taking the time to get to know the person or consider their accomplishments more fully reduces bias.

Leaders have the power to create an inclusive and welcoming culture. The effort will pay dividends in performance, retention, and diversity. Here are five things leaders can do today to start the process.


Five Things You Can Do, Starting Today

1. Reward and recognize individuals in your organization who are doing the hard work of making your workplace more inclusive. Ask yourself:

  • Is service on D&I related committees compensated?
  • Is it recognized in the promotion process?
  • Is D&I work assigned only to those who are underrepresented in your practice or is it the responsibility of everyone?
  • This poll of members of the ASA Committees on Professional Diversity, Young Physician, and Women in Anesthesia suggests recognition and rewards are few and the burden is often unbalanced.

2. Take a tour of your facilities. Ask yourself:


3. Review the diversity of your leadership. Ask yourself:

  • How many individuals from underrepresented groups have leadership roles?
  • How many individuals from underrepresented groups are on the path to leadership?
  • Are they receiving sponsorship? Opportunities to develop? Opportunities to advance?
  • Are their voices heard and their contributions recognized?
  • When they make mistakes, does it disqualify them from advancing?
  • When they raise concerns, are their concerns dismissed or are they told to “lean in”?


4. Review your recruitment practices. Ask yourself:

  • Are biases affecting how we review applications?
  • Do we use best practices in interviewing, with standardized questions?
  • Are biases affecting the compensation packages we offer?



5. Make healthcare equity a component of CME for your group. Did you know:

  • That Black patients and their visitors are more likely to have security called on them than whites?
  • That Black children and adults are more likely to receive inferior pain management?
  • That this is also true for women?

There is a robust literature on disparities and awareness is one mechanism for interrupting bias. Here are a few articles for further reading.

Visiting Black Patients: Racial Disparities in Security Standby Requests (ScienceDirect)

Racism and Health: Evidence and Needed Research (Annual Review of Public Health)

These readings are a great starting point for understanding the current system and committing to work to create a more welcoming workplace. While no single individual can resolve systemic issues of gender and race inequity, everyone’s contributions are needed to address systemic barriers. What actions will you commit to today?


Harriet W. Hopf, MD, FUHM, FASA, is Professor of Anesthesiology and Adjunct Professor of Biomedical Engineering at the University of Utah and Co-Director of the Utah Coaching and Advancement Network (UCAN) in the School of Medicine. She is Chair of the FAER Board of Directors and serves on the ASA Committees on Professional Diversity, Women in Anesthesia, Equipment and Facilities, and Occupational Health.


ASA Community Blog is published as a benefit for ASA members. The views expressed on this blog are those of the individual contributing writers only and do not necessarily represent the opinions of ASA.


Sep 14, 2020 08:34 AM

Thank you Harriet! Change in workplace culture goes beyond recruiting. True change requires a focus on developing the pipeline from a very early stage to ensure a diverse and excellent representation at every level of the organization.