Voices from the frontline: Mardia Shands

For far too long, a variety of systemic barriers have prevented people of color and members of marginalized communities from experiencing the same health outcomes that white patients enjoy. We’re committed to breaking down those barriers, which is why this year we established the Office of Health Equity, Diversity and Inclusion.

The journey to providing more equitable care will be ongoing, and as Chief Officer of Diversity, Equity and Inclusion Mardia Shands, MA, SPHR, SHRM-SCP explains, it will start with practicing cultural competence and humility.

Let’s define some terms. What are cultural competence and humility?

Okay, let’s take cultural humility first. It’s the understanding that you don’t know everything about everyone who walks through your doors. However, you’re humble enough to know that, and subsequently, you enter into that situation mindful of how you approach it. You don’t go into it centering yourself. You go into it centering the patient.

Now, as the caregiver, you’re the expert, and the patient is coming to you for your expertise. But you’re demonstrating cultural humility by asking questions like, “What do you need?” and figuring out what their circumstances are. Once you understand that, you can decide how—given their situation, circumstances, lived experience and background—you can provide care that meets their needs.

And over time, by being culturally humble, you’ll begin to build cultural competence, or your understanding of how to care for patients with diverse backgrounds and beliefs and needs.

How do you teach cultural humility?

You start with understanding what impedes our ability to be culturally humble and to build cultural competence: our innate biases.

What’s interesting about our biases is that they’re always there, but they’re unconscious. They're built by what we see in the media, what we read. They're built through our familial structures and how we were brought up. They're built over our lived experiences. Because of that, we come into situations oftentimes prejudging. It's a shortcut to quickly find a solution or make a decision.

Now if you rely on your biases to make decisions, you’re going to be wrong almost all of the time. So before we can even get to cultural humility, we need to start by training caregivers to be aware of their biases. Each time you walk into a situation with a new patient, you have to pause for a minute and ask yourself if your initial assessment is based in fact or based on your biases. So a lot of our initial training and education is going to be around recognizing unconscious bias and developing tools to disrupt it.

What will that look like?

We’ve actually already built out an implicit, unconscious bias simulation based on some of the issues that we’ve seen in labor and delivery. It walks nurses, doulas and midwives through situations and says, “Here’s what happened. Now let’s replay it and decide what we would do differently.” It teaches skills for more appropriately handling the situation in the future.

I can imagine a lot of our caregivers would say, “I already give my best to every single patient. What more can I do?” What would your response to that be?

My response would be that the data says otherwise. You, as an individual, may do your very best. But by and large, as an organization, the data will say that for encounters with minority patients, we don’t do our best. It behooves all of us to collectively improve the data that we see around patient experience and health outcomes.

There’s a longstanding distrust of health care among minority communities, particularly African-Americans. We can do all the work we want to break down our unconscious bias, but you can’t just put up a sign that says, “We’re culturally competent now.” So how do we build back that trust?

As we start to build out our educational programs, we do it in tandem with our outreach to minority communities and community-based organizations. We share our programming with organizations like the Seattle Indian Health Board, the Urban League, Casa Latina and the GSBA and ask for feedback. We ask what barriers they face related to access and social determinants of health.

We’re not working in isolation to draft programs and initiatives without reaching out to our partners. They are the ones who carry the message back that we care about their community, that if they need care or additional resources, we can provide it. Then when those community members come in and experience it firsthand, it’s further validation that we do what those organizations told them we do.

How else can we support this work?

Continued education and training are the linchpin of our diversity, equity and inclusion efforts. I have experience developing both, but I need a team and additional resources to build a sustainable and robust program.

Because this kind of work has to be ongoing. You’re always working against your biases, so you have to constantly counteract them with education. And accountability is critical; we will need to use data to ensure we reach critical mass, and continue to steward the work and hold one another accountable.

We’re never going to have one-to-one, patient-to-caregiver representation. However, if we have enough people in the organization who understand this critical work around DEI, then we’ll have traction to continue.

Related resources

Diversity and inclusion at Swedish

How equity and inclusion build safer medical systems, stronger communities | The Seattle Times

Swedish names inaugural Chief Diversity, Equity & Inclusion Officer

Swedish's commitment to Black Lives Matter

Help Swedish reimagine patient care by becoming a patient and family advisor