2023 HSR&D/QUERI National Conference

3006 — Identifying and addressing structural racism/racial and ethnic bias in healthcare systems

Lead/Presenter: Michelle Wong,  COIN - Los Angeles
All Authors: Wong MS, Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles; Moy E, VHA Office of Health Equity; Washington DL, Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles; University of California Los Angeles;

Workshop Objectives:
Achieving health equity will require healthcare systems – including VA – to acknowledge and address their contributions to structural racism/discrimination. However, while healthcare systems have taken steps to remedy interpersonal racism, addressing structural racism/discrimination is more challenging. Structural racism/discrimination is often insidiously embedded in practices and policies that seem “race-neutral”. This workshop will provide participants with an overview of structural racism, and facilitate hands-on activities based on the Aspen Institute’s Racial Equity Theory of Change (RETOC) guide for dismantling structural racism to 1) identify areas where structural racism/discrimination exists, and 2) begin to develop a plan to promote structural change.

This workshop consists of three activities. First, we will present an overview of structural racism, including examples in VA healthcare, so all participants have a baseline understanding of structural racism/discrimination and how it differs from interpersonal racism, such as implicit bias (15 minutes). Second, participants will work in small groups to identify how structural racism/discrimination contributes to a specific racial or ethnic health disparity (groups should select a disparity they are familiar with) (25 minutes), and share their findings with the larger group (15 minutes). We will provide participant with domains from RETOC to help identify structural racism: • Organizational policies: affecting resource allocation and guidelines; • Institutional practices: cultural norms, decision-making and standard operating procedures that may seem race-neutral but generate racially biased outcomes; and • Cultural representations: frames, popular images and stereotypes that indirectly contribute to negative portrayals, erasure, or “othering” of racial and ethnic minoritized patients, and/or reinforcing the perspective of White patients as the “norm”. Third, participants will resume working in small groups to develop an action plan for change (20 minutes). Participants will select one organizational policy, institutional practice, or cultural representation identified in the previous activity; for this selection, they will identify key stakeholders necessary for change, develop a “current state” process map of what has produced or maintained the policy, practice, or representation, and then identify areas for change within research (research gaps, data collection, and research approaches to monitor progress), and implementation (best approaches for addressing structural racism, tools for supporting assessment of structural racism, how to share and implement these tools). The workshop will conclude with groups sharing their findings and closing remarks of next steps for dismantling structural racism (15 minutes).

Target Audience:
Anyone with an interest in improving racial/ethnic health equity within VA and an open mind.

Assumed Audience Familiarity with Topic:
Basic familiarity with racial/ethnic health disparities and interested in learning about structural racism and discrimination.