360 - Perceived Culture of Anti-Racism and Equity in a Pediatric Emergency Department

Poster Number: 360
Publication Number: 360.313

Hannah Barber Doucet, Hasbro Children's Hospital at Rhode Island Hospital, Providence, RI, United States; Taneisha Wilson, The Warren Alpert Medical School of Brown University, Providence, RI, United States

Background: As health equity and antiracism have taken center stage in medicine, there remains a chasm between acknowledging the importance of equitable care and fostering true culture change in large organizations. Qualitative data offers an opportunity for more nuanced understanding of departmental culture.

Objective: Describe PEM physician perceptions of bias and antiracism, as well as the culture around race and equity in their emergency department.

Design/Methods: Focus groups were held on a rolling basis during and after a one-year anti-racism and equity educational intervention. Participation was open to all adult & pediatric emergency medicine physicians within one hospital system. Data were analyzed by exploratory analysis to identify common themes.

Results: Five focus groups were held that included 24 providers, of whom 12 PEM attendings. Major themes included the culture of the pediatric emergency department and participant individual journeys. Despite working in different departments with separate nursing pools, both adult and pediatric EM physicians perceived nursing staff as more frequently racist or biased, and expressed concerns over how to best address these differences. Participants noted ways in which bias functioned within their department to impact patient care, both for patients of color and for non-English speaking patients. Participants also emphasized the importance of strong leadership.
When describing their individual journeys, participants shared the ways in which they have become more self-reflective and examples of how their patient care and interactions with colleagues have changed. Participants also reflected on the stumbling blocks they have come across – feelings of guilt or shame at past actions, or non-action; feeling unprepared to address issues they have identified; or ways in which their attempts to change practice or better address bias in care have not always worked well.Conclusion(s): Among this PEM group, issues of bias and race were conceptualized in two major lenses – that of the culture of the department as a whole, and at the level of the individual, in participants self-reflections and actions. Altering the culture of a department can be difficult, but this analysis suggests key areas to focus in encouraging a culture of antiracism in this department – particularly multidisciplinary care, interactions with colleagues, and leadership messaging and actions. Participant’s individual journeys illustrate physicians who are engaged and self-reflective, at times wrestling with how to best integrate antiracism and their awareness of bias into patient care.
HBD CV 1.2022.pdf