Patient preference at a glance
- Many healthcare workers, including some Encompass Health employees, have encountered patients in their careers who denied care based on racial bias.
- Patients are afforded many rights related to personal preference during their care, but not the right to request a clinician of a specific race.
- Encompass Health is proud of its diverse workforce. Our core values guide the way we address these difficult situations.
- Two Encompass Health clinicians discuss past experiences of racial bias in delivering patient care and how they have navigated those challenges.
Encompass Health clinicians have a passion and responsibility for providing a better way to care, helping our patients achieve the best healthcare outcomes. Unfortunately, we must acknowledge that racism and inequality does exist in our society, and in some circumstances, our clinicians face challenges in delivering care based purely on their skin color.
In a recent episode of our inclusion & diversity video series, Tony Hernandez, chief human resources officer at Encompass Health, met with clinical leaders to gain their perspectives on patient preferences and what to do when those preferences are the result of negative racial bias.
Among those interviewed is Vidette Forbes, chief nursing officer for inpatient rehabilitation hospitals in Encompass Health’s Northeast region, who shared a time during her career when she encountered a patient who refused her care after expressing a desire not to be treated by a person of color.
“I entered the room, and the patient made a very disparaging comment,” Vidette said. “It took a minute to adsorb. I continued my dialogue with the patient and explained why I was in his room—to perform an assessment. He continued to escalate and his voice got very loud. He questioned my ability to safely give meds as well as my qualifications as a professional nurse. I felt threatened and humiliated, and I didn’t understand why he reacted so harshly to me.”
Vidette’s experience is not unique. Sam Gates, director of education for Encompass Health’s home health and hospice segment, has also encountered patients in her career who expressed a preference for a clinician of another skin color. She explained that these situations are hurtful and can create strained communication when the desire to provide excellent patient care is met with hostility or opposition.
“I’ve arrived at the homes of patients who made it clear that my skin color was an issue and that my presence in their home was not welcome,” Sam said. “I left those homes feeling like I’d been punched in the stomach, but I know that person is still someone who deserves our care. It just hurts to know that despite my mission to always provide the best care, many patients have refused to see or even consider my competency, experience or heart for their wellbeing.”
When patient preference borders discrimination
In the healthcare industry at large, patients are afforded many rights related to personal preference during their care. But what is acceptable patient preference, and what isn’t? Here’s a look at the legality of patient preference.
- Related to job performance: If a patient (or patient’s family member) complains that a caregiver was not performing some aspect of their job to their satisfaction, it is permissible to make a change in staff assignment.
- Related to gender: It is not permissible to honor a patient’s request for staff of a certain gender unless the request is based on personal privacy/modesty considerations and the caregiver would be required to assist the patient with bathing, toileting or changing clothes.
- Related to nationality: It is not permissible to change a staff assignment based on nationality. However, if a patient complains that he/she genuinely cannot understand a caregiver due to an accent, a change in staff assignment may be made. This may be prevalent if a patient is suffering from hearing loss.
- Related to religion: Religion can never be taken into account when making staff assignments, unless religious beliefs are the basis for a modesty/privacy concern.
- Related to race: Race can never be taken into account when making staff assignments, therefore a patient’s request based on racial preference will not be granted. Staff can be informed of a patient’s racist tendencies, however, and offered the option to be reassigned.
If a healthcare professional encounters a patient who exhibits aggression and denies their care based on personal bias, what can the clinician do? The first step for employees at Encompass Health hospitals and home health and hospice agencies is always to alert your supervisor and to excuse yourself from the patient’s room or home if you feel unsafe.
A member of the hospital or homecare branch’s leadership team can then meet with the patient to find out why they are refusing care, work to ease their concerns and, when necessary, explain to the patient that discriminatory conduct is not acceptable when interacting with our staff.
Our core values set the tone
Vidette believes these situations, while uncomfortable, present an opportunity to show patients why Encompass Health is different, both in our commitment to providing high-quality care and our diversity practices.
“In these situations, I want to know where the patient is coming from. What exactly are they feeling and why?” Vidette said. “We don’t staff our hospitals or home care agencies based on race, so if a patient exhibits a preference for a caregiver of a certain race, that’s our chance to educate them about how diverse our workforce is and how each of our clinicians are qualified to care for them, which can provide some peace and reassurance.”
Sometimes it’s not about proving you’re right, but rather proving you care.
Sam shares the sentiment. “We can’t expect to change the negative perceptions someone may have about other races, but we can show compassion and live out our values. Our behavior and how we respond versus react is how we can change hearts,” she said.
The Encompass Health Way, our Company’s set of shared values, encourages employees to lead with empathy, do what’s right, set the standard, focus on the positive and unite to become stronger together. These values guide the way our staff interact with patients and how we confront challenging situations. Leading with empathy is particularly important, because we know that many patients in our care are experiencing some of the toughest moments of their lives.
“Some patients have experienced a traumatic, life-changing injury or illness,” Vidette said. “In their moment of vulnerability, we can demonstrate care rather than meeting them with more hostility. Discharging a patient is our last resort; we want to be the ones who guide them on their road to recovery. We don’t want to stop their rehabilitation.”
Be the change you wish to see
Sam, too, believes it’s important to stay positive even if you don’t agree with someone’s worldview.
“When they go low, we go high,” Sam said. “Anger doesn’t make anything better, so we refrain from that. Instead we step up and show our hearts to each patient, while still making sure that every employee knows they are trusted and supported.”
As part of both Encompass Health’s inclusion & diversity program and ethics & compliance program, employees are empowered to speak up if they witness a situation that doesn’t feel right, such as overhearing a patient use derogatory terms with a nurse, therapist or other staff member. Vidette believes that those in leadership positions have an obligation to ensure that a culture of trust and accountability is present.
“As nursing leaders, these aren’t situations we can turn a blind eye to,” Vidette said. “We have to address them head on, approach people with humility, develop a rapport of trust with our clinicians and empower our staff to be part of the solution. If we can lead with empathy and help make our communities and our world look like our hospitals—places of diversity and teamwork—then we’ve done something good.”