Most race-related incidents in health care are directed at providers

Although both patients and health care providers are subjected to racial comments and behaviors, providers are more often the target, according to a review of safety incidents by ECRI Institute, a nonprofit patient safety organization.

“This analysis provides a snapshot into the experiences of racial and ethnic minority groups at every level of care delivery,” Dheerendra Kommala, MD, chief medical officer at ECRI, said in a press release. “More needs to be done.”

Researchers at ECRI examined patient safety incidents that were reported to the organization or the Institute for Safe Medicine Practices PSO and took place between July 1, 2019, to June 30, 2020.

Of the 763 incidents analyzed, 503 qualified as relevant. Events were then divided into several categories and subcategories.

Among the most frequent race-related events were:

• the patient or family making inappropriate comments regarding race or ethnicity (56%; n = 283);
• staff making inappropriate comments regarding race or ethnicity (6.6%; n = 33);
• the patient claiming others are racist (22%; n = 113);
• a patient or family report of disparate care due to race or ethnicity (9.3%; n = 47); and
• a staff report of management or supervisor discrimination (3.8%; n = 19).

Other reported, but infrequent, events included patients requesting other providers or staff due to race or ethnicity (1%; n = 5) and no interpretation or translation services being provided (0.6%; n = 3).

In instances where patients or families made inappropriate comments regarding race, 231 were targeted to the health care staff. That was not only the most prevalent event of its subcategory (82%), but of all relevant events (46%). When patients claimed others were racist, it was targeted at staff 96% of the time (n = 109).

When staff made inappropriate comments regarding race, 45% of the incidents were targeted to other staff (n = 15), while 42% were directed at patients (n = 14).

In the analysis, ECRI researchers highlighted several strategies for addressing racism and discrimination, recommending health care providers:

• introduce policies on racist behavior, remarks and requests;
• provide training for staff on how to handle racist requests;
• develop a system to allow patients, family and staff to report incidents of racism, bias and discrimination; and
• explain to patients they have a right to refuse treatment, but not to request certain types of treatment in event of race-related request.

The researchers pointed out that due to data being reported to patient safety organizations voluntarily and based on reports by staff, other race-related incidents were likely missed.

“Furthermore, event report narratives often do not provide all the information analysts would prefer, making it difficult to identify all the factors that contributed to a particular event,” they wrote.

Despite the limitations, the researchers concluded that the data offer “a large enough sample to offer generalizable insights into issues, including the context, causes, and systems issues that contribute to race- or ethnicity-related events.”

References:

• ECRI analysis: Healthcare providers are main target of racial incidents occurring in health systems. https://www.ecri.org/press/ecri-healthcare-providers-target-racial-incidents. Published Oct. 18, 2022. Accessed Oct. 21, 2022.
• Racial and ethnic disparities in health and healthcare. https://assets.ecri.org/PDF/Press/2022-ECRI-ISMP-PSO-Deep-Dive-Full-Report.pdf. Accessed Oct. 21, 2022.