rel="nofollow" href="#uc4c6c3e8-624d-51bc-a8b0-c9dcc3515275">Chapters 7 and 8. Chapter 9 looks at resilience in practice and how approaches such as the ‘most respectful interpretation’ in assessing the motivation and intentions of others can be transformative in the relationships of healthcare professionals both with each other and with our patients.
Equality, diversity and inclusion in healthcare resilience
We cannot consider practitioner resilience and its relationship to patient safety without acknowledging that our lofty proclamations of equality for all is far away from the lived experience of many of our colleagues. For example, in the UK National Health Service (NHS), there is a significantly higher percentage of black, Asian, minority ethnic (BAME) workers than in the general population (21% versus 13.8%). In London, while 43% of the NHS workforce is from BAME backgrounds, they occupy only 14% of board‐level positions in local healthcare (Kings Fund, 2018).
Staff experiences include the following:
‘…patients really can be difficult. I mean, recently I had a patient who told me that I was the wrong colour to be English’
(Kings Fund, 2019)
While initiatives such as the British Medical Association’s Equality Matters campaign and the BMA Charter on Racism in Medicine have sought to address this, the extent of the problem was brought into sharper focus during the 2020 pandemic, when it emerged that the death rate among BAME healthcare workers was disproportionately higher than non‐BAME practitioners (Box 1.2). This was a tragedy set against the backdrop of a health service which would collapse without BAME staff.
There is evidence that BAME staff struggled more to obtain adequate PPE as compared to their white counterparts (Box 1.3). Nowhere was this more tragically illustrated than in the case of Abdul Mabud Choudhry (Box 1.4).
Box 1.2 Proportion of Covid‐19 related death in UK healthcare workers from BAME background.
UK healthcare workers from BAME background have been disproportionately affected by the Covid‐19 pandemic. This is manifested by increased death rates across groups of healthcare workers:
21% of all healthcare workers are BAME.
63% of healthcare workers who have died were BAME.
20% of nursing staff are BAME.
64% of nurses who died were BAME.
44% of medical staff are BAME.
95% of doctors who died were BAME.
Source: Adapted from HSJ Survey (2020).
Box 1.3 Access to personal protective equipment (PPE) in UK healthcare workers from BAME background.
A survey published by the Royal College of Nursing on 28 May 2020 found that BAME‐category nursing staff were more likely to have difficulty accessing adequate PPE during the Covid‐19 pandemic:
43% of BAME staff had enough eye and face protection, as compared to 66% of white British nursing staff.
37% of BAME nurses did not have enough fluid‐repellent gowns, as compared to 19% of white British nurses.
53% of BAME respondents had been asked to reuse single‐use PPE, as compared to 42% of white British respondents.
40% of BAME staff received training in what PPE to wear, as compared to 31% of white British respondents.
Source: Based on Royal College of Nursing (2020).
How are intelligent kindness and resilience relevant here? An individual cannot be resilient in a system which fails them. Many forms of discrimination including those based on race, gender, sexual orientation and belief exist in healthcare. As individuals and organisations, we need to recognise discrimination and make changes to create a level playing field for all. An individual’s resilience is challenged if their workplace is permeated by discrimination. We should be mindful that our colleagues experience many repeated ways of discrimination:
‘Modern racism is far more subtle. It’s indirect, it’s oblique and it is far more difficult for others who are not on the receiving end of it to detect’.
– Professor Binna Kandola OBE
Our own growth as resilient practitioners includes being able to empathise and understand the lived experiences of those who work alongside us. The concept of whistleblowing as a component of patient safety is now well established. Alongside this, we need to embed within our professional values the need to be ‘active bystanders’ for our colleagues whose resilience and well‐being is undermined by discrimination (Box 1.5)
Box 1.4 Story of Consultant Urologist, Mr Abdul Chowdhury.
Abdul Mabud Chowdhury was a consultant urologist at Homerton University Hospital in East London. After training in Bangladesh and working in Zimbabwe, he moved to the United Kingdom to work in the NHS.
At an early stage of the Covid‐19 pandemic, Mr Chowdhury appealed to the UK prime minister for ‘appropriate PPE and remedies’ to ‘protect ourselves and our families’.
Five days later, he was admitted to hospital and subsequently died of Covid‐19.
Dr Chaand Nagpaul, chairman of the British Medical Association (BMA), said it was ‘so tragic’ that the 53‐year‐old had died after issuing a warning about a lack of PPE.
Source: Based on BBC News (10 April 2020).
Box 1.5 The role of the active bystander.
Active bystanders show that certain types of behaviours are not widely accepted by others and break the silence that has previously allowed them to thrive. Active bystanding to address behaviour targeted at minority or marginalised groups such as BAME students is also very important in demonstrating support and inclusion.
The BMA Charter advocates an ABC approach:
Assess for safety: if you see someone in trouble, ask yourself if you can help safely in any way.
Be in a group: it is safer to call out behaviour or intervene in a group, and where this is not possible, report the behaviour to others who can act.
Care for the person who may need help and ask them if they are okay.
Source: BMA (2020).
‘What hurts the victim the most is not the cruelty of the oppressor but the silence of the bystander’.
– Elie Wiesel, Holocaust survivor
Conclusion
The global pandemic has reminded us of the need to protect healthcare workers in order to enable them to optimally care for patients. A UK Institute for Public Policy Research report in April 2020 (Thomas and Quilter‐Pinner,