Equity in the Moment: Pursuing Inclusive Care Together

There are times when individuals at all levels in our system engage in biased behaviors that adversely impact the working or patient care experience. We have procedures like the UW Medicine Bias Reporting Tool and the Patient Safety Network in place to report all types of safety concerns.

The Acute Care Burn, Plastic and Pediatric Trauma Unit at Harborview Medical Center is continuing the conversation. They started Equity in the Moment (EIM), an initiative designed to help unit staff recognize and overcome healthcare inequities.

“We want our patients to know we see them in these moments,” says Tara Lerew, BSN, RN, NE-BC, nurse manager of Acute Burn Care, Plastic and Pediatric Trauma at Harborview. “And instead of working to repair these events after the fact, we want to prevent them. We are learning to recognize bias and to be advocates for change.”

Creating a safe space for discussion

While EIM’s overall goal is building a more culturally humble and sensitive healthcare environment, creating a forum for open conversation was the first step. During November and December 2020, Lerew and her colleagues met with Harborview Medical Center’s Equity, Diversity and Inclusion (EDI) leadership to ensure everyone received the same staff training in equity.

From there, they started monthly EIM meetings. They typically hold sessions during late afternoons and early evenings with voluntary attendance.

“Our meetings are a safe space for people to share their experiences with seeing or being a part of bias and prejudice,” she says. “We want everyone to be on a journey toward gaining EDI knowledge and breaking down bias.”

In addition to discussing events that occurred with patients, the group also brainstorms strategies they can implement and actions they can take to support a more culturally sensitive approach to care.

Tackling topics for inclusivity

According to Christine Ijiomah, BSN, RN, assistant nurse manager for 8EH, EIM has expanded its discussion topics over the past three years. Initially, nurses explored their first-hand experiences with individual patients. Now, they also address specific issues around equity.

Among other subjects, EIM expanded its conversations to include:

• Gender-affirming care
• Gender bias
• Language barriers
• Cultural humility that centers race, bias and microaggressions

Ijiomah says, based on these discussions, 8EH and EDI leadership launched several initiatives designed to proactively improve equity. For example, Harborview now stocks hair products designed for Black, Indigenous and People of Color (BIPOC). Interpreters are trialing a new iPad for video conferencing at the bedside for patients who speak English as a second language. The team is also working on translating hospital kitchen menus that offer vegetarian, vegan, kosher, gluten-free and Halal options for patients with specific dietary preferences or restrictions into 10 languages.

Improving through HEALS

Addressing inequities can’t always wait for a monthly meeting, though. Lerew says that in addition to EIM, 8EH adopted the HEALS Model — Halt, Engage, Allow, Learn and Synthesize — to consistently improve equality for patients and medical staff. This program, developed by the University of California at San Francisco School of Nursing, ensures healthcare professionals recognize and focus on moments of inequity as they happen.

“Within the HEALS framework, we actively step into a conversation when we witness microaggressions,” she says. “We use this model with all colleagues who work with us from the burn, pediatrics, rehabilitation, psychology and therapy departments.”

HEALS encourages everyone to stop and talk about events in real time. This way, they can self-reflect and share their opinions about what happened with colleagues. Pausing gives everyone a moment to step back, analyze a situation and potentially improve it.

Expanding EIM

Since its inception, EIM has fundamentally changed how the 8EH nursing staff interact with patients and each other, Lerew says. The success of the program inspired the ICU Burn and Pediatric Unit at Harborview to hold their first EIM meeting in September.

Lerew and her team plan to expand the program’s reach throughout Harborview. As an initiative with grassroots support, it aligns with the hospital’s commitment to providing high-quality, compassionate care to all patients.

“We’ve invited multiple units to come and participate in our meetings, so the program grows organically,” she says. “We want bedside staff to be engaged and to want to have these conversations. We hope this will become a movement where more clinical teams ask to implement EIM.”