Developing leadership interventions for black and minority ethnic staff: A case study of the National Health Service (NHS) in the U.K

Anti-racist interventions to reduce ethnic disparities in healthcare in the UK: an umbrella review and findings from healthcare, education and criminal justice

OBJECTIVES

To assess the evidence for anti-racist interventions which aim to reduce ethnic disparities in healthcare, with a focus on implementation in the UK healthcare system.

DESIGN

Umbrella review.

DATA SOURCES

Embase, Medline, Social Policy and Practice, Social Care Online and Web of Science were searched for publications from the year 2000 up to November 2023.

ELIGIBILITY CRITERIA

Only systematic and scoping reviews of anti-racist interventions reported in English were included. Reviews were excluded if no interventions were reported, no comparator interventions were reported or the study was primarily descriptive.

DATA EXTRACTION AND SYNTHESIS

A narrative synthesis approach was used to integrate and categorise the evidence on anti-racist interventions for healthcare. Quality appraisal (including risk of bias) was assessed using the AMSTAR-2 tool.

RESULTS

A total of 29 reviews are included in the final review. 26 are from the healthcare sector and three are from education and criminal justice. The most promising interventions targeting individuals include group-based health education and providing culturally tailored interventions. On a community level, participation in all aspects of care pathway development that empowers ethnic minority communities may provide an effective approach to reducing ethnic health disparities. Interventions to improve quality of care for conditions with disproportionately worse outcomes in ethnic minority communities show promise. At a policy level, structural interventions including minimum wage policies and integrating non-medical interventions such as housing support in clinical care has some evidence for improving outcomes in ethnic minority communities.

CONCLUSIONS

Many of the included studies were low or critically low quality due to methodological or reporting limitations. For programme delivery, different types of pathway integration, and providing a more person-centred approach with fewer steps for patients to navigate can contribute to reducing disparities. For organisations, there is an overemphasis on individual behaviour change and recommendations should include a shift in focus and resources to policies and practices that seek to dismantle institutional and systemic racism through a multilevel approach.

Creating comics, songs and poems to make sense of decolonising the curriculum: a collaborative autoethnography patchwork

Decolonising the curriculum is a complex endeavour, with the potential to cause harm as well as benefit. People doing the work might find themselves questioning their personal and political identities and motives, it is common for people to get disillusioned. While surveys and toolkits are important to help us start the work, we are interested in finding out how decolonising practices can be sustained. We believe to practise meaningfully in this area we need to understand ourselves as practitioners, make sense of the work and have deep connections with colleagues and possibly our institutions.This research uses collaborative autoethnography; our personal experiences, reflected through the lenses of each other's point of view; to help us know ourselves and make sense of our practice. We also show how art, in the form of comics, poems and a song, can be used to deepen our research by adding meaning, connection and joy. We present this research as a patchwork text of writing, art and conversations. Our work is underpinned by theory, particularly drawing on Sara Ahmed and bell hooks. It is produced by the three of us to illuminate the process of decolonising a curriculum. We see this paper as part of our collective resistance: resistance to colonialism, to scientism and to inhumanity. We hope you will find resonances with your practice, and perhaps discover new ways to find meaning and connections.

Attending to our conceptualisations of race and racism in the pursuit of antiracism: A critical interpretative synthesis of the nursing literature

Race and racism are matters of urgent concern for the international nursing community. Recent global events have presented the discipline with an opportunity to generate and sustain long overdue discussions. However, with this opportunity comes a need to consciously attend to what we mean by race and racism, especially in the context of the nursing literature. Indeed, the development of antiracism depends on how we conceptualise race and racism; it is these conceptualisations that actively shape the scope and priorities of antiracist organising and action. The aim of this critical interpretative synthesis (CIS) is to examine conceptualisations of race and racism in the nursing literature by drawing on contemporary race scholarship. The synthesis of diverse literature is enabled through the explorative and expansive process of the CIS method. This review generates three synthesising arguments-a problem 'of' not 'for'; conceptual inconsistencies and drift; and reliance on the lens of experience-that both critique and contribute to the nursing literature. In the pursuit of antiracism, this article urges us to pay close attention to our conceptualisations of race and racism by illuminating the pitfalls that occur when our conceptualisations are inconsistent, contradictory, or simply neglected.

Mental well-being and diversity, equity, and inclusiveness in the veterinary profession: Pathways to a more resilient profession

Mental well-being (MWB) and diversity, equity, and inclusiveness (DEI) continue to be critical within the veterinary profession but there is less information regarding how professional associations around the world tackle these issues. A mixed-method study including an international online survey in English (n = 137 responses via snowball sampling), fourteen interviews, and two webinars was used to identify the availability and impact of MWB and DEI support programs for veterinarians. Survey results showed that more veterinary organizations designated MWB and DEI challenges (54%, n = 43/79 and 58%, n = 45/78, respectively) as a key priority area than veterinary clinics (26%, n = 15/57 and 33%, n = 19/57, respectively). Whereas, MWB support programs were available in a moderate number of mainly English-speaking countries, DEI support programs were available in only a few countries and focused primarily on specific groups, with an unknown impact due to their recent implementation. Universally, survey respondents believed activities for specific groups, such as MWB webinars, training, and awareness campaigns, as well as MWB/DEI helplines and DEI peer-to-peer support programs had a high impact (median 3.5–4/5) yet were underemployed by both veterinary organization and veterinary clinics. Further feedback from respondents during focused interviews indicated that requiring initial and continuing training as well as tailored group activities would be most beneficial to improve MWB/DEI throughout the veterinary professional career. There are many areas of the intersection between MWB and DEI that remain to be elucidated in the future studies. Having a sufficient sample size, improving accessibility, and addressing varying cultural perceptions are the main challenges, as seen in our study. To truly address MWB and DEI disparities, change is also needed in veterinary workplace culture and environment. In conclusion, raising awareness for an inclusive profession, including increasing openness and acceptance to enhance DEI and destigmatizing MWB challenges, is needed to ensure a thriving, modern veterinary profession.

Rejecting the myth of equal opportunity: an agenda to eliminate racism in nursing education in the United States

BACKGROUND

Unfortunately, racism and discrimination against Ethnic minority (EM) has been globalized, universally infecting industries worldwide, and the field of nursing has not been spared. In the United States (US), overt and institutionalized racism (IR) still permeates the fields of nursing, nursing leadership, and nursing education. Programs to address these disparities, and efforts by nursing professional societies and nursing education policymaking bodies to address racism in the nursing field, specifically with nursing leadership and education, have met with little success.

OBJECTIVE

The purpose of this paper is to illustrate the existence and magnitude of racism and its impact on the fields of nursing, nursing leadership, and nursing education, and to make evidence-based recommendations for an agenda for reforming nursing education in the US.

METHODS

A narrative literature review was conducted with a focus on pulling together the strongest evidence on which to base policy recommendations.

RESULTS

Based on the available literature, we put forth five recommendations aimed at modifying nursing education in the US as a strategy to counter IR in the US in the nursing field.

CONCLUSIONS

Recommendations to address IR in nursing focus on nursing education, and involve implementing programs to address the lack of opportunity for both EM students and faculty in nursing, developing an anti-discriminatory pedagogy, and incorporating diversity initiatives as key performance indicators (KPIs) in the process of approval and accreditation of nursing programs.

Workplace diversity management in Australia

Purpose

– The purpose of this paper is to identify Australian managers’ attitudes and understandings regarding workforce diversity management (WDM) and the practices and incorporation of WDM in organisations.

Design/methodology/approach

– Methodology is quantitative. A questionnaire in the form of a self-administered survey instrument was mailed to 650 managers (325 HR managers and 325 other managers) in Sydney, Melbourne and Brisbane.

Findings

– The research found that workforce diversity is not especially well understood or appreciated; especially by non-HR managers. Organisations appear generally not to prioritise WDM and levels of senior manager engagement with the topic are tentative. Statistical analysis highlighted considerable divergence of opinion across the surveyed group.

Research limitations/implications

– As an exploratory study, further research is encouraged to better understand cause and effect relationships pertaining to the findings.

Practical implications

– There are implications for HR managers or those in related roles who might design, implement and promote WDM initiatives. There are implications for consultants, employees and senior managers regarding education, awareness and support of diversity objectives.

Originality/value

– Addresses a gap in the literature by looking at contemporary attitudes and practices regarding WDM in Australian organisations. Provides the first empirical comparison between HR and other managers on the topic.

The association between trainee demographic factors and self-reported experience: Analysis of General Medical Council National Training Survey 2014 and 2015 data

Objectives

To investigate whether demographic factors are associated with self-reported experience amongst medical trainees in the UK.

Design

Retrospective analysis of survey data.

Setting

General Medical Council (UK) National Training Survey data for 2014 and 2015.

Participants

A total of 105,549 responses were provided from 68,551 participants when no data were removed. After removing data to preserve participant anonymity, there were 64,278 participants providing 99,076 responses.

Main outcome measures

Considered trainee factors were gender, ethnicity, country of primary medical qualification, grade, post specialty and deanery. Self-reported outcome measures were ‘overall satisfaction’, ‘adequate experience’, ‘workload’, ‘clinical supervision’, ‘educational supervision’, and ‘access to educational resources’.

Results

The experience of medical trainees across various indicators is differentially related to gender, ethnicity, country of primary medical qualification, grade, post specialty and deanery.

Conclusions

It is demonstrated here that trainee factors are associated with subjective experience across different indicators. Further work is required to explore the reasons behind this, and how this relates to trainee quality of life, work performance and career progression.

Promoting equality for ethnic minority NHS staff--what works?

NHS organisations are now being judged on indicators of ethnic diversity. Naomi Priest and colleagues look at the international evidence on how they should tackle discrimination