As discourse around diversity, equity, and inclusion (DEI) reaches everyday clinical practice, anesthesiologists must consider the meaning of DEI and its relevance to patient care. People want to work in a culture where they are appreciated for their contributions and feel supported. Not only does this improve work productivity and satisfaction, it translates to better outcomes for our patients (Natl Med Assoc 2019;111:383-92; asamonitor.pub/3UHDP0P; asamonitor.pub/3Y6g59H). The recent DEI movement draws many parallels to the patient safety movement that began over 20 years ago. Both movements are philosophically grounded in a systems-based approach to change individual behaviors and outcomes. Both use organizational culture as a linchpin to change deeply entrenched beliefs (To Err is Human: Building a Safer Health System. 2000). Therefore, we can incorporate DEI principles to address patient safety challenges in our everyday practice.
Tip 1: Consider the role of bias in safety events
Does your quality and safety review process consider how bias contributes to adverse events? Bias is often implicit, making it hard to detect (N Engl J Med 2022;387:105-7). One way to better elucidate the role of bias in safety is in the composition of quality and safety teams. Instead of having quality and safety be the sole responsibility of one departmental officer, make quality and safety a team approach with people from a multiplicity of perspectives and lived experiences. Diverse teams are better positioned to identify bias. Diverse teams make for a shared sense of responsibility, obtain more accurate information, and can address barriers to patient safety in creative ways (asamonitor.pub/3BjkZ9q). While diversity often implies race, gender, or ethnicity, it also represents the inclusion of people from an array of backgrounds and includes age, seniority, spoken language, professional background, and clinical expertise.
Tip 2: Make inclusive practices the standard of care – the use of translator services
An inclusive culture is one that values the diversity of lived experiences and where there is a sense of belonging. In this culture, people are more comfortable raising concerns without fear of criticism or punishment. It facilitates open dialogue, better event reporting, and a culture of learning after adverse events. Similarly for our patients, an inclusive culture makes them feel valued and facilitates trust and satisfaction. One simple way to make your practice more inclusive is by ensuring that translator services are the standard of care for patients who require language assistance. Easily accessible translator services reduce errors by enhancing the accuracy of information, communication, and trust – all of which are simple ways to improve patient safety (Health Serv Res 2007;42:727-54). Make the use of translator services a priority for any encounter where language may be a barrier to perioperative care.
Tip 3: Measure the disparities in safety events
Equity rests on the assumption that, at times, more resources are needed for certain groups to reduce disparities. Ensuring equity in safety requires understanding how factors such as self-reported race, gender, socioeconomic status, and spoken language may contribute to safety events. This requires having access to demographic data and analyzing it across important safety metrics. While there are undoubtably challenges in collecting demographic data, by having a measurable outcome, known disparities in safe perioperative care can be better addressed (ASA Monitor 2022;86:39-40).