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How to Build Antiracist Medical Facilities

August 10, 2023

Many hospital and institutional policies, procedures, and practices are inherently unjust and perpetuate bias – and often, we don’t think twice about this. For instance, in most hospitals, the patient care teams make rounds during normal working hours. If the parent cannot get off work and is not there, the team may assume that the parent is not interested or unengaged in the child’s care. This can have downstream consequences.

This week, Pediatrics is early releasing an article entitled “Antiracism: An Ethical Imperative,” by a group of pediatric bioethicists from 9 US institutions, led by Ian Wolf, PhD (10.1542/peds.2022-059804). This article was the culmination of a workshop and a subsequent working group that identified institutional policies, procedures, and practices in children’s hospitals that perpetuate structural racism and discussed potential antiracist strategies.

In the workshop, 7 categories of hospital policies were identified:

  • Hospital security and staff safety
  • Reporting to child protective services
  • Behavior contracts
  • Patient visitation
  • Hospital routines
  • Medical decision-making and clinical care guidelines
  • Employment and human resources

It would take too long to list the myriad of examples in which everyday workplace policies, procedures, and practices contribute to structural racism. However, here are a few examples:

  • Reporting any family who leaves against medical advice without understanding the reason that they are leaving
  • Requiring a parent to sign a behavior contract or not be allowed to visit their hospitalized child
  • Describing a patient in a progress note or a patient sign-out as “difficult”

I would encourage you to read this thoughtful article. In addition to other examples, the authors provide suggestions that may help to mitigate these racist practices and encourage a more antiracist framework.

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