Scarlett McNally: We can all do better to encourage diversity to benefit staff and patients
BMJ 2024; 386 doi: https://doi.org/10.1136/bmj.q1709 (Published 01 August 2024) Cite this as: BMJ 2024;386:q1709
- Scarlett McNally, professor
- scarlettmcnally{at}cantab.net
Follow Scarlett on X @scarlettmcnally
I attended two LGBTQ pride events recently and have been thinking about what it means to be an ally. Through my work I try to pay back the support I’ve received from other people from diverse backgrounds. Around 30 years ago I did some surgical training in Brighton, then referred to as “the gay capital of Europe.” I benefited from staff and patients treating me with respect in my role, rather than constantly having to justify my position as a woman surgeon as I did in other settings. I later spent a decade on the council of the Royal College of Surgeons of England, so I hope that my presence lent some establishment gravitas at the college’s recent pride event and has contributed to new members feeling that they belong.
There are two important reasons for improving diversity and inclusion. Firstly, we need people to be secure and supported to flourish at work. Secondly, patients get better outcomes when treated by diverse teams.12 The problem is that building diverse teams is challenging23—and some historical approaches, such as ignoring difference, can make this worse. There’s ample evidence of a problem: 91% of women doctors experience sexism,4 one in four staff from minority ethnic backgrounds experience harassment from patients,5 and microaggressions are an obstacle staff face while doing their job.6
The human brain is wired to notice difference, often unconsciously. I wrote my college’s first guide to unconscious bias, which is something we all have but must be ready to compensate for when meeting and interacting with people.7 Organisations need to clarify what’s expected from each role, such as highlighting the skills needed to chair a meeting7 and examine processes so that they don’t inadvertently exclude some people.
Positive difference
People must be allowed to thrive in their workplace, but our current approach to diversity hasn’t been successful in achieving this. For years, the NHS’s mandatory “equality and diversity” training has only taught us what the lawyers at our organisations want: to pretend not to notice a candidate’s turban or pregnancy at the point of an exam or interview. This approach of ignoring difference helps promote equality at assessments, but it feels like the opposite of promoting diversity in a longer term working relationship. If a person from a diverse background is on your team, you should take time to listen and provide support that can help them develop to be their best. Managers need to know that it’s helpful to ask and to listen to staff and that difference is positive.
Some generalisations are acceptable. For example, it’s not sexist to say that woman doctors in general are more likely to take parental leave. But workplaces also need to adapt to each person’s unique and specific needs. If we can’t get a staff member through a particular career phase, we often lose them from the talent pipeline.8 I was grateful, when returning from sick leave, to have reasonable adjustments put in place. I now try harder to include people whose needs have been overlooked in the past.
My new top tip is using the team brief included in the National Safety Standards for Invasive Procedures9 from the Centre for Perioperative Care. This team brief creates a bonding moment at the beginning of every operating session or procedural session, explaining what’s expected and welcoming every person in the team. This helps everyone to feel included and encouraged to do the best they can that day.
We need every staff member to feel that they belong and that their role and experience have value. NHS organisations need to change processes to ensure that this happens, but the biggest win is from each person knowing that they have a huge impact on improving culture, which benefits staff and patients alike.
Footnotes
Competing interests: Scarlett McNally is a consultant orthopaedic surgeon, deputy director of the Centre for Perioperative Care, and president of the Medical Women’s Federation.
Provenance and peer review: Commissioned; not externally peer reviewed.