"Why I want to talk about racism"
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Dr Anu Obaro, St Mark's Hospital, London North West University Healthcare NHS Trust
Published on: 01 December 2020
My impact story describes how I created the presentation, "Why I want to talk about racism" and how I approached sharing my experience and insight with colleagues. To date, the talk has been viewed over 4400 times and the far-reaching impact has been worth the journey it took to create. Talking about racism is painful, uncomfortable, and challenging but by tackling it, I hope we can make the NHS more equitable for staff and patients.
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Impact story overview
I was compelled to share my lived experience of being a Black, female doctor in Britain. In part, I wanted to encourage dialogue about racism and discrimination and how it affects not only our lives but also our profession. My desire was to encourage my colleagues and leadership within my Trust to go beyond talking about these issues and instead make active commitments to being anti-racist.
The situation before the project began
Prior to the project
I recognise that as a doctor and academic, I experience a level of access and privilege that many other Black people may not. Nevertheless, I'm always a Black woman before anything else, and that is the lens through which I am viewed and treated. Daily micro-aggressions and thankfully, less often blatant discrimination are challenges that must be faced and navigated. When combined with the ravaging of communities of colour by COVID, including many personal family members and friends who died in the first wave, there was a new potency about the impact of racism and inequality in my life.
The catalyst for change
George Floyds' murder was the catalyst for me to go from experiencing these challenges to more actively and decisively addressing them. I felt an overwhelming strength of grief for him. Before I had somewhat benignly accepted the status quo, resigned to the reality that this was just how life was, but now I needed to speak up too. Plus, I kept hearing that, 'the situation in America is terrible, but that sort of thing doesn't happen here'. I didn’t agree, the injustice of Stephen Lawrence's death, amongst many others, is a sad testament to this.
I wanted the chance to express my feelings and views on racism. I've had to educate my children about racism, to equip and protect them. The reality of systemic racism means that their experience of life will be different to many others. I wanted to understand more about the detail of racism, the construct of race, the impact of it on the NHS and the vocabulary of this movement.
I wanted to share these insights and spoke to the Dean of the Academic Institute of the hospital where I work to get permission to present at an all-staff Grand Round.
I gave a talk on 25 June 2020, watch the recording here. It turned out to be an emotional experience in preparation and delivery, but despite this, I am so pleased I did it. The topic was well received by my immediate colleagues and has been embraced by the Trust leadership from the CEO down. A cohesive strategy is bringing together several Trust initiatives and there is a commitment to improving the representation of all ethnic minority staff in the senior ranks of the organisation. These are modest steps moving in the right direction.
I’ve had the opportunity to get involved in several programs and initiatives to support changes we need to make in my Trust. The presentation has facilitated me being able to contribute to the work of the System Transparency And Re-education (STAR) division of the African Caribbean Medical Association UK (ACMA), General Medical Council (GMC), National Institute for Health Research (NIHR) Imaging Workforce Group (IWG) and the Royal College of Radiology (RCR) to address representation and support diversity, equality and inclusion. It’s vital that we take action on racism and become collectively anti-racist to make a difference.
Set-up and roll-out
Declarations of interest
Partnerships and collaborations
This project was conducted independently by myself.
Project funding and support
No funding or other formal support was provided for this activity.
St Mark's Hospital is the national bowel hospital, and part of London North West University Healthcare NHS Trust. Before the pandemic, we had a weekly Grand Round lecture where invited internal and external speakers presented on topics related to bowel pathology. During the pandemic, this meeting moved to a monthly, online format. An email request went out to staff requesting volunteers to fill these monthly slots. The killing of George Floyd and the impact of COVID-19 prompted me to ask our Dean if I could present my response to these issues.
Understanding the issue
Up until this point I had never given a talk on racism and I needed to firstly, understand my emotions and the terminology to accurately articulate my experiences. Plus I wanted to understand how racism impacted my profession and healthcare in general. So I began with lots (and lots) of background reading. The BMJ series on racism in medicine was a great place to start.
Methodologies and models
The content of my talk evolved as I continued to research. I moved from the catalyst of George Floyd and COVID-19 to the impact of racism on my family and myself to the reality of systemic racism and the inequalities this perpetuates in the NHS. I saw patterns of inequalities replicated in my Trust and wanted to share these stats and figures, but also share knowledge and potential solutions. I wanted to leave my audience with a sense of urgency to make changes, but also the feeling that their input and influence was important.
Project catalyst: additional information
George Floyd’s murder prompted an abundance of writing on race and inequality and I read many articles related to this. Plus there was no shortage of pre-existing expert research and material on these issues. My talk is a bit of a journey, similar to the journey of research that I went on: Looking at parallels between the UK and US. Looking at the justice system, the healthcare system and our culture in general. Where possible I also looked for real data vs just anecdotes or opinion pieces. I found the local and national Workforce Race Equality Standard data particularly useful.
To be honest, when I set out I didn't have a clear objective. I just wanted to help people understand what it felt like to be part of this collective grief. I needed to share why the death of a stranger felt so personal and how that tragedy shouldn’t be meaningless. On reflection, I think hearing the lived experience of a colleague or friend in a way that forces you to see them more holistically can be a really powerful way to create better empathy and understanding. And ultimately, that can drive real change.
Baseline data collection
The Grand Round lectures are for all staff: clinicians, nurses, trainees and admin staff. I sent out a pre-talk survey of five questions, along with the invitation, to get an idea of what people thought about racism. The 77 responses provided me with a sense of my colleagues' understanding and views on the issue and got the audience pre-engaged in the topic.
I've attached the questions and proposed enhancement to these questions if you are interested in doing a survey of your own.
Project mapping methods
I did literature searches, read blogs, original papers, government and NHS data, watched Ted talks and webinars, listened to podcasts and radio shows. I bookmarked and saved important pieces; fact-checking as much as I could, going direct to the source where possible.
Excellent sources of information on race and racism as it relates to healthcare include the BMJ series, NEJM series, NHS Confederation and the national and local Workforce Race Equality Standard (WRES) data. I'm pleased to share my reading list as an attachment in the useful materials section of this impact story.
I had a conversation with our Dean, to gain permission to present on this topic at Grand Round. As it was a departure from the usual topic content I had to make sure that she felt it was a suitable forum. She gave her approval and full support and was crucial in creating a safe and supportive environment for the dialogue. She was an ally before I even knew what an 'ally' in social justice was, and gave me the room I needed to tackle this topic.
I went through my presentation with the Dean in advance. She encouraged me to share more of my personal experience and insight. This support allowed me to be more vulnerable and honest about my thoughts on racism and its impact on my life.
I think it's imperative that if you're going to share experiences that have been personally painful or traumatic that you do so with the full support of a senior member of staff. There should be clarity about how to debrief after and how your transparency can contribute to the race equity agenda.
Key project resources
I didn't use any extra resources; just committed time to the necessary research.
Challenges and stumbling blocks - Capability - knowledge, skills and abilities
Preparing for the talk was as much a journey of self-education as it was a desire to share data and personal experience. Initially, it was a very emotional, visceral undertaking, however, as I read and understood more about the social construct of race and the role of power and privilege in racism, I felt more confident in articulating my reflections.
We have a responsibility to continue the lifelong learning of how and why society behaves the way it does; and how these constructs can disadvantage groups of people. This work requires engagement from people of all ethnicities.
Challenges and stumbling blocks - Opportunity - external factors
The main stumbling block was the seemingly universal apprehension that surrounds conversations about racism. I was worried about talking frankly and what that may mean for me, professionally. There are countless examples of people who have spoken up about such and subsequently been labelled trouble makers. I suppose I just wanted to speak to an open-minded audience about a critically important issue. To do so I had to overcome my personal fear and reservation and be bold, hoping for the best outcome. The Dean provided a forum for me to speak at, which I took.
Challenges and stumbling blocks - Motivation - human factors
I didn't know if people, especially colleagues who were not from an ethnic minority, would even think there was a problem with racism in society or the NHS. So, I used the survey to try and gauge this. I also had to examine my personal motivations. Given how contentious issues of race can be, I wanted to make sure that my talk wasn’t just an outpouring of pain and hopelessness. I needed to have a strong factual basis, with considered reflections that not only challenged my audience but motivated them to want to be anti-racist.
The initial draft of my talk was overly factual and quite impersonal. I had to go through multiple revisions to better capture what I wanted to share. Having my husband and later the Dean look at my slides helped me to get a better steer of how my content was coming across. I think there's greater authenticity in sharing your vulnerability, but that does come with an emotional cost and it’s really important to acknowledge that.
Risk & safety
Risk assessments and considerations
Volunteering myself, not knowing if the audience had an interest or desire to hear about racism, made me feel vulnerable, and to a degree exposed. I needed to get permission to gain access to the Grand Round audience. In doing so the Dean became an ally who took on the responsibility of creating a safe space for me to speak honestly.
This was a solo project although I had the backing and support of our St Mark's Academic Institute Dean and St Mark's Hospital Foundation Chief Exec.
Normally, around 40 people attend the 7:30 am weekly slot. The presentation, which was profiled as an 'Extra-Special' Grand Round, to make it clear it was going to be different from the normal offering, received an audience of more than 90 staff on the day.
As mentioned, the Dean's role as an advocate and ally was pivotal. Advertising of the talk by the Chief Exec and administrative team also helped to maximise the audience in attendance that morning.
Uniting the team
Mobilising the team
As mentioned, a pre-survey was issued to staff. A post-event feedback survey was also issued that I'll cover later.
Communicating with the team
All communications around this project were email-based. The presentation was profiled as an 'Extra Special' Grand Round, to flag that this was going to be different from the standard content. Following the success of the initial talk, I was also interviewed for the Trust-wide weekly newsletter, The Pulse, and a link to the talk was included with that.
Staff were able to watch live and the presentation has been profiled internally.
This was for an internal audience, so I didn't involve patients. However, I did find and present data on implicit bias in healthcare decision-making by doctors. It’s important to recognise that racism can be subtle as well as overt and that implicit biases may affect how we treat our patients contributing to health inequalities and poorer outcomes in particular groups.
As this was an internal presentation there was no need to involve patients in the project.
Communicating with patients
No patient communications were required as part of this project.
Impact and key takeaways
I sent my initial email suggestion about speaking on anti-racism on 11th June and the presentation was delivered live on 25 June 2020.
The presentation was recorded and can be watched here. There was an immediate positive response with a lively question and answer afterwards. Between 25 June and 18 November, it has been viewed almost 4500 times.
As a result of the talk and making new connections on Twitter, I designed an infographic for Yvonne Coghill CBE (Former Director of NHS Workforce Race Equality Standard Implementation) capturing her '7 As of Allyship'. The infographic has been liked almost 1500 times, re-shared over 700 times and is being used by Trusts across the country as part of their diversity and inclusion work.
As well as the pre-talk survey, I also collected written feedback from the live audience where I asked how useful the presentation was. Some of the responses to the question, “Is there anything you would do differently now?” included: "Have difficult conversations. Your challenge for us to do some self-reflection before walking into spaces where our bias could affect someone’s life is powerful. I will be doing this." and "I intend to stand up whenever and wherever I hear racist talk or sentiment".
I also received hundreds of emails, text messages and social media comments giving feedback.
7As of Allyship
Our actions as a Trust to address diversity, equality and inclusion can only have a positive impact on the patients we care for. I cannot credibly quantify a number, but I hope that as many as possible will benefit since this is crucial work to ensure we treat our patients and colleagues equitably.
I've received positive feedback and thanks from colleagues in my Trust, other UK Trusts, universities, schools, individuals working in the private sector and organisations in the US.
Having received hundreds of messages in different forms it’s very difficult to put a specific number on how many people have been impacted, but it's far more than I could have imagined.
Within my Trust, I hope the work we continue to do on diversity and inclusion will improve staff experience and opportunity for career progression in groups currently absent from leadership roles.
Key enhancements to patient care
While it will be difficult to quantify, I hope the broader actions of my Trust will help us to continue to improve our patient care.
Savings and efficiencies
I am fortunate to work in a Trust that recognises the issue of racial inequality, the impact of this and one that is motivated to address it. Poor representation of ethnic groups in senior leadership and management is a real issue that we are working hard to tackle. As a result of my presentation, I am actively working with our Chief Exec and Equality, Diversity, and Inclusion (EDI) team on this agenda. We are reviewing our Workforce Race Equality Standard (WRES) data, as well as the very important Staff Survey to create an informed strategy
Staff engagement and morale
I've experienced lots of positivity and gratitude from colleagues, which has been overwhelming. I wanted to leave people with a sense of responsibility and urgency to be anti-racist in all areas of their lives. To recognise why we must do this important work, and that we all have a sphere of influence which we can impact. We need to do more than have conversations about this – my goal was not for more talking, but for people to be motivated to action. From the feedback I received, it seems that this has resonated with people, which is incredible.
Multiple streams of work are being undertaken at my trust to support EDI. I have regular meetings with our CEO and the EDI team and numerous ongoing initiatives are going to be aligned into a cohesive anti-racism strategy (which all organisations should have). Our Trust wants to embed a culture shift, engaging with the executive and non-executive board members, all levels of leadership, and middle management. There has been an appetite across the organisation to engage and take action. This will continue to address the EDI disparity within our Trust which I discussed in my presentation.
For the NHS workforce, I think there needs to be a focused effort to understand why certain groups are missing from higher pay bands, in particular senior management. What are the barriers to this attainment and how can these be overcome? The onus should not solely be on the individual since the system has flaws that continue to marginalise ethnic groups – in particular Black people.
Sharing our story is incredibly impactful and leadership needs to listen to the experiences of their workforce (achievable through your local WRES data). Everyone (staff and patients) need to know that their voice and experience matter.
Colleagues have shared my original talk link on social media. I was also an invited speaker and panellist for an American radiology education platform, MRI Online, and that talk has been included in an anti-racism primer for the Massachusetts General Hospital Association of Program Directors in Radiology’s (APDR) Diversity, Equity, and Inclusion (DEI) curriculum. That presentation, which I adapted for an American audience can be viewed here. This web page has other presentations and resources which you might find useful.
Final thoughts & acknowledgements
Considerations for future project implementation
You might have noticed that in this impact story and my presentation, I try as much as possible to avoid using the term 'BAME'. I find it's a term that attempts to homogenise the experience of anyone who isn't White, thereby completely glossing over the nuances which make our experiences different. There are inherent differences in the way life is experienced by a Black man versus a Chinese woman for example - yet they are both considered BAME. An excellent breakdown of this issue can be read here.
Author’s key takeaways
I'm extremely grateful that this presentation has given me the opportunity to work with:
1) ACMA (African Caribbean Medical Association UK) as part of their STAR division who advocate for organisational accountability in racial equity and are working with the GMC
2) NIHR Imaging Workforce Group, to help raise the profile of academia in radiology and encourage under-represented groups to get involved
3) a new organisation focussed on widening participation in radiology
4) my Trust, on diversity and inclusion.
Talking about racism has given me the chance to have an impact far beyond just the initial presentation, which is incredible.
Why the author is proud of this project
I gave this talk because I wanted to make sense of my pain and articulate my experiences and those of my family. I am humbled that other people, doctors, in particular, have expressed gratitude and commonality in this shared experience. People connected to it on an honest level which was beyond my expectations. Hearing that people not only valued hearing me but feel motivated to start or continue their own work on anti-racism makes me hopeful.
There are no quick wins here, but I feel less disillusioned than before. We will make progress.
Author’s words of wisdom
Do not underestimate the emotional load of anti-racism work. Whether you are creating presentations, conducting webinars or writing strategy. As an ethnic minority person engaged in this work, it can be incredibly draining and painful. Do what’s safe for you and protect your emotional wellbeing. For my White colleagues – you have untold power to make a difference in this space. It’ll be emotional and draining for you too but in an entirely different way. Implement the 7As. We have to do this work together daily. It’s not a destination you arrive at, it’s a lifelong journey.
To access all of the PDF materials mentioned in Dr Obaro's impact story in one place, click here.
To watch the on-demand recording of the recent webinar with Dr Obaro and guests - Equality and diversity: Taking an anti-racist stance in your day-to-day - click here.
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We amend these terms from time to time. Every time you wish to use our site, please check these terms to ensure you understand the terms that apply at that time. These terms were most recently updated on 16th December 2020.
We may make changes to our site
We may update and change our site from time to time to reflect changes to our platform, changes in law or policy, our users' needs and our business priorities or other such reason.
We may suspend or withdraw our site
Our site is made available free of charge.
We do not guarantee that our site, or any content on it, will always be available or be uninterrupted. We may suspend or withdraw or restrict the availability of all or any part of our site for business and operational reasons. We will try to give you reasonable notice of any suspension or withdrawal.
When you register, you agree to provide true, accurate and complete information about yourself as prompted by the sign-up form (“Registration Data”).
When you register you will choose or be provided with a username and password. The details must be used solely by you. Sharing your username or password with any other person or making it available to any other user on the site is strictly prohibited. Accordingly, you agree to:
We accept no liability for any losses, damages or costs arising from or in relation to your failure to comply with these requirements.
How you may use material on our site
We are the owner or the licensee of all intellectual property rights in our site, and in the material published on it. Those works are protected by copyright laws and treaties around the world. All such rights are reserved.
You may print off and download copies, and may download extracts, of any page(s) and supporting documents from our site for your personal use and you may draw the attention of others within your own and other organisations to content posted on our site.
When you share content, you must not modify the paper or digital copies of any materials you have printed off or downloaded in any way, and you must not use any illustrations, photographs, video or audio sequences or any graphics separately from any accompanying text. The entire context of an impact story should be complete when sharing.
You may learn from the impact stories and use any or all of the know-how and supporting documents to support your work.Our status (and that of any identified contributors) as the authors of content on our site must always be acknowledged. Please include the wording as an acknowledgement, reference or footnote: Presented with thanks to [author], [affiliation] and www.antiracism.bob.health read the full impact story here: [INSERT URL].
You must not use any part of the content on our site for commercial purposes and personal gain without obtaining a licence to do so from us or our licensors.
You will be asked for feedback on the site and impact of the content you have read, downloaded or shared. You should take every opportunity to feedback in order to help all other users learn more and the site owners to enhance the learning experience.
Do not rely on information on this site
The content on our site is provided for general information only. It is not intended to amount to advice on which you should rely in relation to the fitness of purpose and merchantability of any product or service or the efficacy of any process described. No warranty is given, whether express or implied including but not limited to implied warranties of merchantability, fitness for a particular purpose, non-infringement or course of performance. If you take any action or refrain from taking any action in response to the content on our site you do so on the basis of your own professional judgement, or after obtaining professional or specialist advice.
Although we make reasonable efforts to update the information on our site, we make no representations, warranties or guarantees, whether express or implied, that the content on our site is accurate, complete or up-to-date.
We are not responsible for websites we link to
Where our site contains links to other sites and resources provided by third parties, these links are provided for your information only. Such links should not be interpreted as approval by us of those linked websites or information you may obtain from them.
We have no control over the contents of those sites or resources.
How to complain about content
If you wish to complain about content on the site, please contact us on firstname.lastname@example.org.
We respect the intellectual property rights of others. It is our policy to respond to any claim that content posted on our site infringes the copyright or other intellectual property rights of any person.
If you are a copyright owner or authorised on behalf of one, and you believe that the copyrighted work has been copied in a way that constitutes copyright infringement that is taking place through use of the site, you must submit your notice in writing to the following address email@example.com and include in your notice a detailed description of the alleged infringement.
You may be held accountable for damages (including costs and legal fees) for misrepresenting that any content on our site infringes your copyright.
Our responsibility for loss or damage suffered by you
We do not exclude or limit in any way our liability to you where it would be unlawful to do so. This includes liability for death or personal injury caused by our negligence or the negligence of our employees, agents or subcontractors and for fraud or fraudulent misrepresentation.
We exclude all implied conditions, warranties, representations or other terms that may apply to our site or any content on it.
We will not be liable to you for any loss or damage, whether in contract, tort (including negligence), breach of statutory duty, or otherwise, even if foreseeable, arising under or in connection with use of, or inability to use our site or use of or reliance on any content displayed on our site. Without limiting the foregoing we are not liable to you for any loss or damage suffered by you as a direct consequence of the content you upload to our site.
You agree not to use our site for any commercial or business purposes, and we have no liability to you for any loss of profit, loss of business, business interruption, or loss of business opportunity, goodwill or reputation or any indirect or consequential loss or damage.
If defective digital content that we have supplied, damages a device or digital content belonging to you and this is caused by our failure to use reasonable care and skill, we will either repair the damage or pay you compensation. However, we will not be liable for damage that you could have avoided by following our advice to apply an update offered to you free of charge or for damage that was caused by you failing to correctly follow installation instructions or to have in place the minimum system requirements advised by us.
How we may use your personal information
You may use our site only for lawful purposes.
You may not use our site:
In any way that breaches any applicable local, national or international law or regulation.In any way that is unlawful or fraudulent or has any unlawful or fraudulent purpose or effect.For the purpose of harming or attempting to harm minors in any way.To bully, insult, intimidate or humiliate any person.To send, knowingly receive, upload, download, use or re-use any material which does not comply with our content standards. See further under Content standards.To transmit, or procure the sending of, any unsolicited or unauthorised advertising or promotional material or any other form of similar solicitation (spam).To knowingly transmit any data, send or upload any material that contains viruses, Trojan horses, worms, time-bombs, keystroke loggers, spyware, adware or any other harmful programs or similar computer code designed to adversely affect the operation of any computer software or hardware.
You also agree not to access without authority, interfere with, damage or disrupt:
any part of our site;any equipment or network on which our site is stored;any software used in the provision of our site; orany equipment or network or software owned or used by any third party.
We are not responsible for viruses and you must not introduce them
Whilst we make all reasonable efforts to monitor our site for defects, we do not guarantee that our site will be secure or free from bugs or viruses.
You (or your organisation if you access our site using your organisation's devices) are responsible for configuring your information technology, computer programmes and platform to access our site. You should ensure adequate anti-virus protection is in place on all devices you use to access our site.
You must not misuse our site by knowingly introducing viruses, trojans, worms, logic bombs or other material that is malicious or technologically harmful. You must not attempt to gain unauthorised access to our site, the server on which our site is stored, or any server, computer or database connected to our site. You must not attack our site via a denial-of-service attack or a distributed denial-of service attack. By breaching this provision, you would commit a criminal offence under the Computer Misuse Act 1990. We will report any such breach to the relevant law enforcement authorities, and we will co-operate with those authorities by disclosing your identity to them. In the event of such a breach, your right to use our site will cease immediately.
Rules about linking to our site
You may link to our site, provided you do so in a way that is fair and legal and does not damage our reputation or take advantage of it.
You must not establish a link in such a way as to suggest any form of association, approval or endorsement on our part where none exists.
You must not establish a link to our site in any website unless are authorised to do so or unless the website is owned by you.
We reserve the right to withdraw linking permission without notice.
The website in which you are linking must comply in all respects with the content standards set out in these terms.
If you wish to link to or make any use of content on our site other than that set out above, please contact firstname.lastname@example.org.
Governing law and jurisdiction