Successfully achieving equitable healthcare for all

by Rhiannon and Philippa Oakley, Oakley Coaching

Inclusion in healthcare is essential, and manual therapists must make efforts to ensure that all patients feel welcome and safe in their clinic. As a manual therapist, you have a unique opportunity to create a space that is inclusive to all people.

We have been privileged to meet and work with a wide range of people and organisations making great strides in equality, diversity and inclusion (EDI) and be inspired by their progress and vice versa. We diversified our communications training platform to provide consultancy services to both private healthcare organisations and various NHS trusts so we get to see first-hand what and where progress is being made.

If you’re reading this thinking “I provide all my patients with the same great standard of care regardless of their background”, you’d be absolutely right – we’ve never yet met a chiropractor who doesn’t… however, equitable healthcare and equal healthcare are two very different things.

So where do we start?

Educate yourself on Diversity and Inclusion

To be actively inclusive, it is essential to educate yourself on diversity and inclusion. Start by learning about the different cultures, backgrounds, and identities of your patients and community. There is a wealth of research to help you understand how issues of equality, diversity and inclusion impact someone’s health experiences and health outcomes.

Specific healthcare conditions are more prevalent within certain communities, and an awareness of this can help us deliver the appropriate care and provide patients with the best clinical advice possible. This starts with building an understanding of what those specific conditions and care needs are, and how we can formulate an evidence-informed approach to supporting these patients.

Educate yourself on the barriers that your patients may face when accessing healthcare, and start asking questions about why certain patients might not come into your clinic, which can help you create a space that’s inclusive to all. We like to encourage our clients to build relationships with local community groups – this is a great place to start to find out first-hand the barriers that they may face when accessing care and what more can be done to help them feel welcome within your clinic.

Be representative

Your website and marketing materials should reflect the diverse community that you serve, using images of people from different backgrounds, ages, ethnicities, body types and abilities. If you’re looking for something a little more specific, stock photo libraries such as The Gender Spectrum Collection and Disability. In feature photos of people that go beyond the clichés. Be conscious, 1however, that your website should be representative and not mere lip service.

Use Inclusive Language

Language is powerful, and it can create a welcoming or unwelcoming environment for patients. Many Electronic Health Records (EHR) systems now provide an opportunity to ask patients for their pronouns when booking appointments, which is a simple way to highlight your inclusive practice to your patients. Consider whether your intake forms or documentation also need reviewing- for example, questions that say “women only” can exclude people who menstruate.

Awareness of microaggressions

We’ve all heard the trope of the physically petite (often female) chiropractors surprising their larger patients who don’t think they’re capable of adjusting them. Perhaps you’ve also been told “You don’t look old enough to be a chiropractor” or someone has asked, “where are you from originally?” Or “Can I touch your (Afro-textured) hair?” These are examples of microaggressions.

If you think of a microaggression as an insect sting- one is irritating but unlikely to fully disrupt your day, whereas one hundred repeated small stings over the course of the day and that initial small sting has become a much bigger problem. Microaggressions have previously been dismissed in the media as “hypersensitive nonsense’ and yet research has shown that all people, regardless of whether they belong to a minoritised group or not, respond negatively to microaggressions. (It’s just that people in minoritised 2groups experience them more frequently!)

Multiple studies link microaggressions in healthcare to poor outcomes from care- both because of the impact they have on trust and rapport in the therapeutic relationship, but also because of their links with depressive symptoms , adherence to treatment advice and biological markers of stress. Be aware of your 34 5own language and that of others, and seek to sensitively challenge microaggressions when you hear them.

Active inclusivity

When we ask practitioners we work with if they are inclusive of all patients, the answer is always “Of course! I welcome everyone to my clinic.” There is a mismatch between what practitioners say and what patients believe- with practitioners believing it ‘goes without saying’ that they welcome all patients, and research showing us that patients from marginalised communities often feel unwelcome or not-included in a healthcare setting.

A simple inclusivity statement on our website can be a starting point to make a positive and public-facing commitment to inclusive healthcare.

Our role as BCA members

Equality, diversity, and inclusion (EDI) are crucial for providing quality healthcare and improving health outcomes for all patients and we predict this is going to be a topic we will all need to focus our attention on. Chiropractors who actively promote EDI within their clinics can create a welcoming environment that provides culturally competent care that honours our patients’ intersectionality, leading to better health outcomes and reduced health disparities. As BCA members, we are uniquely positioned to support these patients with the highest standard of clinical care, clear communications, and our robust commitment to putting our patients first in all we do, helping to create a more equitable and inclusive healthcare system for all.