Fostering an Inclusive Workspace

Editor's note: This text-based course is an edited transcript of the webinar, Fostering an Inclusive Workspace, presented by Natalie Phillips, AuD.

Learning Outcomes

After this course, learners will be able to:

• Define diversity, equity, and inclusion.
• Identify populations of individuals who have experienced inequalities in society along with the intersection within hearing healthcare environments and formulate appropriate responses to biased environments and scenarios.
• Describe resources that improve culturally competent care and foster diverse and inclusive workspace environments.

Introduction

In this course, we will be discussing inclusion and fostering an inclusive workspace. First of all, I was by no means an expert but learned a lot in doing research and talking to many people surrounding diversity, equity, and inclusion. I hope that this information will be helpful in your clinical experiences. 

In this course, we are going to walk through some different environments and experiences. By talking through these experiences, we can plan appropriate responses to those particular experiences.  

The Changing Workplace

I'm going to start with thinking about the changing workplace. How is it changing? There are lots of things that have changed and we have to evolve with those changes. Sometimes it's in the way we communicate; with our patients and staff with different terms and verbiage that we use. Sometimes it's the culture we're trying to keep up with what's going on around us, as well as the culture of even our own practices. In our own clinics, how we do our jobs is changing. In the last year and a half, we've noticed that there are a lot more telehealth options and other things that we have had to change.  

Diversity

Audiology has a variety of ways that we experience diversity, equity, and inclusion. Often people use these terms interchangeably. Sometimes diversity can be simply stated as in our job title and services; audiologist versus an ear nose and throat physician, or a primary care physician, or a hearing instrument specialist. Those are different types of titles that we use in audiology. Maybe it's jobs within our practice, or in industry, ENT, or an educational audiologist.  Regardless of practice type, we should be asking ourselves, are we treated equitably? Or, if you're looking at a private practice owner versus an audiologist that works with, or for an ENT, are we treating each other the same?

We can look at job titles within our practices; the boss, the owner, the front desk, the manager, the medical assistant, the staff. There are lots of different titles even within our practices. Does everybody get equitable treatment?  Maybe there are gender differences; female versus male. Gender pay equity has been discussed in our profession. Audiology is predominantly female as a profession, although there are men in the profession as well. We have female-only groups in audiology that provide support. Still, we should also examine if, at times, we go too far with exclusivity and leave our male colleagues out of the conversations. There's a fine line of saying, okay, this is a diverse population, but we need to recognize it, provide inclusivity and different opportunities. When it gets to the point that you step over bounds to exclude other people because you're trying to include people, it defeats the purpose.

We should also think about how we manage individuals with disabilities and determine our inclusiveness for individuals with hearing loss, developmental disabilities, brain injuries, with age-related cognitive issues. Are we providing this inclusion in our practices for patients and perhaps employees?  

Insurance is another way that we are looking at providing inclusive services. That could be Medicaid. Or Workman's Comp, how many times have you seen a Workman's Comp on your schedule? And you're like, "Oh man! Oh, okay." Like you already have these thoughts in your head, thinking that particular person will be a certain way because of their insurance. Whether they're self-pay as well.

Finally, we should examine how we are structured to serve diverse populations and people of color.  Are we providing that inclusivity in our service to people of color?  Do the brochures in our office represent our community.  Do we have appropriate color chips for different skin tones?

What does Diversity mean?

When I started forming this course, I interviewed a lot of people.  I asked each of them, what does diversity mean to you? What I found was a lot of different answers.  Responses ranged from "meeting someone where they are and letting them teach you" to a description of a character or physical traits that differ from someone else.   Differences in upbringing, how we see the world, opinions can vary from person to person.  Diversity is recognizing the unique individual differences or a person and respecting the value that that experiences bring.  One person commented that they defined diversity as acknowledging that everyone is unique or different, but we are still together.

Common Types of Diversity

Diversity also is less about what makes people different and more about understanding the similarities, accepting, and then valuing the differences. Common types of diversity include race, age, nationality, ethnicity, culture, gender identities, physical and mental ability, professional experiences, political views/opinions, spiritual/religious beliefs, citizenship, location, family/marital status, job function, department, seniority, and union affiliation.   

Equity

Equity is looking at fair treatment across the board. Fair treatment equates to accessible opportunity for all people. It doesn't matter your identity, but you're creating an environment where there's a fair playing field. To create an equitable environment, we first must recognize that there are biases and inequities.  During my interviews with audiologists, I asked about the biases and inequities they have experienced.

We've talked about things that happened when they were growing up because those are some of the things as a child you don't necessarily notice.  You don't see the bias as much when you're not looking for it. But what happens is when you're growing up, and you're experiencing these things, you become more aware and conscious that it could happen.  While growing up, the people that guide that young person into thinking what they think are the older people. Even though they might miss the bias because they're not looking for it, they're still learning how to be more aware of it.

With the colleagues that I have talked to, obtaining a degree was interesting. Although they felt welcome, whether it was in their school environment, education, whether it is in a professional environment, in a clinic, they could always tell that there was something just a little bit different. Not necessarily that it has to be outwardly said like I am this person of color.  That's something that you see outwardly.

Inclusion

Inclusion is still different from diversity and equity. Inclusion means a variety of people that have the power, the voice, and the decision-making.  These individuals should come from different backgrounds and bring a variety of perspectives to the table.  An inclusive environment means that various team members and employees feel their voice is going to be heard.  

When thinking about inclusion, it is important that groups, let's say women, for example, are represented and that they feel included.  We have to acknowledge there are longstanding gender norms and salary discrepancies that have inhibited inclusion.  We should all be thinking about inclusion and having an inclusive workspace, that not only are you giving a variety of people a seat at the table, but also allowing them to have that voice at the seat of the table. Maybe it's employees, and perhaps it is their point of view. The common misconception is that environments that have diversity and equity naturally have inclusion, and that's not necessarily true. 

It's important to stop and evaluate what you're doing in your particular clinic. To see if you are having that inclusive environment. Or if you can get your employees involved to talk about that. Because employees' points of views are super important, you want to ask them, do they feel a sense of community and connection, or do they feel that they contribute daily, or do they feel that they share a sense of purpose with their coworkers and peers?

The Cost of Racism

The Social Justice Resource Center evaluated the cost of bias or racism in the U.S. There's wage and hiring discrimination, service discrimination, and something that is becoming more talked about is capital investment discrimination. I was thinking about some corporate organizations making it much more lucrative to hire somebody younger, based on the benefits that they have to payout. They offer younger employees a higher wage.  This creates a cost!  According to this Social Justice Resource Center, the cost of racism or bias in the U.S. based on some of these forms of bias is costing the U.S. $2 trillion.

The Cost of Bias on Diverse Populations

Have you ever thought about how it would feel to be considered the "token" anything?  This often refers to someone of a particular characteristic in a group.  Whether it is living, whether it is working, the individuals I interviewed often described being considered the token individual.  Some people feel that over time of being the "token" person, they developed  low self-esteem because of the name-calling due to people not being aware of appropriate verbiage that has changed.

We must consider how we are communicating? How are things changing around us? Are we changing with them? What is the appropriate vocabulary?  Think about times that individuals were teased growing up because of the food that they brought or the way that they dressed, right?  These actions can impact a person over time and can contribute to low self-esteem.  I had a story of someone who shared that growing up. They used to bring a sandwich that had chutney on it, which to that person represented their culture.   But over time, they were teased, saying that it was, "Oh, they brought that green slime again." And so, again, over time in that particular environment, he tried to trade in his lunch or asked his parents not to make that anymore.

You wonder if people are racially insensitive or that just people don't know things, right? Maybe it's just ignorance and immaturity. One odd perk that I found, though, is that token or affirmative action is what people have in place in different policies that can be in favor of the person of color, or the race or the gender, depending on if they use it or not, in the educational program.  One of the people I interviewed sat with an application and decided whether or not they should list their race; because they didn't want to be taken on as that token person in that particular environment.

Code-Switching

Code-switching is a strategy of behavioral adjustment to successfully navigate interactions that can affect well-being, economic advancement, and or physical survival. This can include stylist speech, behavior, appearance, maybe expression to optimize the comfort of others, or quality of service, or even employment opportunities. It often occurs when there's a negative stereotype. People that have to code-switch it's mentally draining because they always have to be on, and they always have to be aware because it's this strategy of behavioral adjustment.

It's interesting because the people that I talk to, code-switching comes naturally to them because they have this feeling. They know when they have to adjust, and they adapt quickly. They don't say in their heads, "I'm going to code-switch now," But it has been ingrained in them to say, you need to survey what's going on. And you're the person that has to change because of what's going on in the environment. 

Maybe they are trying to fit in because they're trying to be hired.  Or they were trying to get a promotion, different things like that. Many people in diverse populations have to learn and automatically code-switch, which can be mentally and emotionally draining. Companies need to begin to understand why there's a segment of people that can't truly be themselves and code-switch. 

Healthcare Disparities

For Patients

Let's look at healthcare disparities for patients.  There was a resource from dosomething.org that looked at the years between 2013-2017. Unfortunately, 34-40% of black native American and Hispanic patients receive lesser-quality healthcare than White or Caucasian patients. It's kind of shocking to hear that, but I started to think, like, why do you think that that would happen? Maybe it is based on what they have for insurance. Perhaps it is socioeconomic status? That they may not be as proactive for the prevention of health issues.

It's so hard to tell, why over four years that 34-40% of black native American and Hispanic patients receive lesser-quality healthcare. If you think about people walking into your offices, it's not that we say, "Oh, okay, I see the color of your skin. I'm going to treat you with lesser value," right? Because we don't. But the truth is that they did this research, and they did find that they did receive lesser-quality healthcare. 

For Professionals and Service Providers

I wanted to look at other healthcare disparities for professionals and service providers. The Naval officer nurse that I spoke to had a great perspective on equity in healthcare. He explained that, when you're in the military, they like to make an excellent first impression, right? Everything is very clean, neat. They have professional experience, mainly because he's a nurse. People immediately know that they can trust them. They are establishing this when you first walk into the room, whether you wear a white coat or not. The first impression is critical.

When you're talking about hiring and employment opportunities, it seems like there are already equal opportunity protocols in place for workplace hiring and employment. According to the International Labor Organization, companies with more inclusive business culture and policies see a 59% increase in innovation and a 37% better assessment of consumer interest and demands.  Evaluating your business culture is so important because it allows your employees, staff, and you to have some great ideas or have some innovative ideas to be better as a business. 

It Takes a Village

As I mentioned earlier, I interviewed several fellow professionals in preparation for this course.  It was a pleasure learning about some of the things that they have gone through.  With the help of these professionals, we will discuss some specific cases and how each of them could be handled. 

Case Study #1: Politics

The first case experience is a patient comes in and openly talks about politics with other people in the waiting room, as well as asks them and you about your political stance.  Do you let them speak freely? Is accepting their diverse opinion something you need to allow in this particular situation? Does it come down to allowing their free speech, or does it come to where you have to think, is it making somebody in your office uncomfortable?

In this situation, my recommendation is to know what you're willing to talk about and what you allow in your workplace. If that means letting the patient know of your policies in place, both in the waiting area and in your back office.

I do not share my political beliefs. If the other patients are noticeably uncomfortable, I call the patient who was discussing politics to the back room and kindly would ask them to stop.

Case Study #2: The Complimenter

The next one is how you handle the patient that continuously compliments the women at the front desk about their dresses and skirts; so much that it makes them uncomfortable, and they have to look ahead on the schedule to make sure they wear slacks that day.  This is a form of diversion that borders on or could be considered harassment.  This is inappropriate, and we need to keep this professional and handle this situation for our employees.  

A lot of the time, I didn't know that was happening until the patient left. Then my front desk would come up to me and say, "Oh my gosh, that person made me so uncomfortable because of this." And I said, "Oh my gosh, you guys have to tell me this so I can address it at the time." Again, equip your front desk about policies, give them appropriate responses, have a plan to follow up, but also to stop those comments and behaviors at the time that it's happening. Management needs to have a conversation with the patient about his inappropriate behavior. Someone needs to educate the patient about how he is making them uncomfortable.

Case Experience #3: Student Placement

For the next one, a person of color is a student and struggles to decide whether to apply for a placement or a job and list their race.  This decision is because, as a student, they were told that they were accepted to the program because of the diversity quota that had to be filled.  In this individual case, the person tried to surround themselves with people who will help with confidence as it continues to grow through these different experiences. To know that some people have some insecurities about how their careers begin.  I would encourage this person to think about the intent of why you're applying for that job or that placement.  Is this placement going to help you reach your goals?

Case Experience #4: Labeling

A person of color is a professional, and a patient walks in and says they are here to see the oriental doctor or the colored doctor. The recommendation is to have an open dialog with your staff about what language is acceptable in your clinic.  Then to teach people along the way, to see you as a doctor first and not the oriental doctor or the colored doctor or whatever it is.

Have that script ready for staff to address the situation and say, "He or she has a name, and it's Dr. Phillips." It doesn't have to be an issue, but be very diplomatic about it. Hopefully, aiming for a positive outcome because sometimes, when patients come in, and they know there's a person of color, they can let their guard down. So look at every opportunity as sharing and learning about respect. 

Case Experience #5: Removing Habit / Hijab

What about the case in which a patient has a headpiece or hijab that needs to be removed for evaluation. Don't assume that the patient will be upset if you ask them to remove their headdress. I think one of the biggest questions that you can ask when you're walking into the booth and about ready to start the testing would be, what can I do to make you more comfortable? I thought that was the most straightforward question that you can ask is, is there anything that I can do to make you more comfortable?  Explain to the patient what is necessary for testing and then let them lead.  

Case Experience #6: Transportation Challenges

Let's imagine that one of your staff went through some changes in their life and no longer has transportation to work, and will have to use public transport, a carpool or possible like Uber or taxi to work. All right, so this one is a little bit different.  This speaks to an equitable environment.  Depending on your work environment, you could think about putting policies in place around start times and working hours or stipends for both auto and public transportation.  Remember, the equitable environment is about making it an even playing field for people that have had changes in their lives.

Resources

Doctors for America is a national 501C organization that promotes advocacy and education.  This group has several different resources for you to either use in your office or whether or not you want to use it for working with patients.

One of the people I interviewed for this course, Sandy, was the producer of the film "Because of Sam." In this film, they interviewed Sam and his mother and found out that a lot of medical professionals did not know how to treat him. He had a developmental disability. It's a 50-minute movie, and there's a 30-45 minutes study guide that you can sit with your staff and go through it all and talk about different things.

Books to Read and Research

There are so many books and resources available.  Here are a few.   Many of them show racial hierarchy, how the American society looks at racial discrimination and the justice system, that is in that "New Jim Crow" book; "White Fragility" is also another one, just looking at unconscious bias and defensive behaviors toward racism. "Pride Against Prejudice" challenges the reality of being different with current and historical debates on the quality of disabled people's lives. "Fundamentals of Disability Inclusion" reviews disability sensitivity in the 21st century for individuals and organizations.  It looks at culture, special needs and provides tools and techniques for different settings where conflict and communication arise.