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For the last four years, colleagues at HealthPartners have been experiencing simulated racism as part of clinical training.
It’s a good sign if the idea of racism (even simulated racism) makes you feel uncomfortable. Chances are you’d like to avoid racism altogether. But the reality is that many health care professionals experience micro or macroaggressions on a daily basis. If you’re not someone who experiences racism, you likely work with someone who does. And it’s important for everyone to know what to do in response to racist behaviors.
In this episode of Off the Charts, Sumaya Noor, a hospital medicine physician assistant at Regions Hospital, and Ryan Aga, director of clinical simulation at HealthPartners, discuss a clinical simulation that’s helping build an antiracist culture. This training simulation has received national attention and is the subject of an article published in the NEJM Catalyst. Listen to the episode or read the transcript.
What happens during the clinical simulation
A clinical simulation is a way to safely practice real-life medical situations without putting anyone at risk. These simulations are often used to improve patient care. The one Ryan and Sumaya discussed is special because it helps people build the skills to recognize and respond to racism, so they can be an “upstander,” which is someone who speaks up when they see unfair or harmful treatment.
During the simulation, a person acting as a patient makes racist remarks to a person acting as a nurse. The role of the participants is to decide how to respond and what to do next. After the simulation, there’s a debrief, which gives the learners time to reflect, discuss, ask questions and share their own experiences.
“This specific simulation helps us really learn how to react and respond when in a situation like this,” Sumaya said. “There are many ways of going about it, but silence is definitely not one of them.”
Unfortunately, rooted in real life experiences
This clinical simulation was sparked by events that took place in February 2020 while Sumaya was working the night shift at Regions Hospital, but it helps to fill a gap that has been around for much longer.
“Sumaya had two episodes of back-to-back racism projected upon her as an emergency room technician,” said Ryan. Even though there were colleagues who heard the racial slurs, no one acted or came to Sumaya’s defense.
“As a person of color, as a Muslim woman, events of racism, microaggressions, macroaggressions aren’t new to me, but what made this specific situation unique was that I was around my colleagues and I didn’t have the support that I needed at the time,” Sumaya said. “I felt that this was enough, and it would be unjust to myself, but also other people who face similar events to let this go.”
The action that Sumaya took was to talk with Ryan, who at that time was the emergency room nurse manager at Regions Hospital. “When I shared this story with Ryan, he took it upon himself to create actionable change,” she said.
Turning reality into simulation
Ryan felt an “utmost responsibility” to do something actionable and different. “It seemed like the tactics that were put in place before about how we’re delivering training and education really weren’t working,” he said.
When he became part of the clinical simulation team later that year, he had an a-ha moment. He said he remembers thinking, “This is the way that we can really make impactful change – through the constructs of simulation.”
Ryan asked Sumaya to share her experience with the clinical simulation team. Based on her story, the team developed a clinical simulation to replicate the situation in a space that can be safe and brave.
Uncomfortable but important
Since it was created, about 1,000 HealthPartners colleagues have gone through the simulation. The general consensus is that the experience is really difficult but also very important.
Host Kari Haley, who has experienced bias and racism throughout her life, recalled that going through the simulation was “very uncomfortable.” But she also said, “It’s really hard to feel the impact of it, unless you’re made uncomfortable. And with that, hopefully growth and learning occurs [sic].”
Feedback captured using pre- and post-surveys has been positive. “It’s been really cool to see that the broad collective wants this and they feel even in the most emotionally charged simulation, that we’re still cultivating a space of bravery and safety,” Ryan said. In fact, 96% of respondents said that the simulation was a safe, brave space to learn.
Still, there are some who believe this sort of simulation may be retraumatizing and that the organization shouldn’t be supporting it. Sumaya understands these concerns.
“Every time I’m involved in the simulation … it feels uncomfortable,” she said. But she believes that experiencing difficult feelings as part of the simulation serves a greater purpose.
“I’m hopeful that if other colleagues face similar situations, that they’re able to stand up and be upstanders,” she said.
Making meaningful change at HealthPartners and beyond
Building an antiracist culture takes ongoing, purposeful work by people, organizations and society as a whole. For the past four years, this clinical simulation has helped create awareness about racism and change behaviors.
Ryan and Sumaya believe there’s more they can do to help foster an antiracist culture and appreciate the support from HealthPartners to keep moving forward and to extend the reach of their learnings.
“I’m just so grateful to be in an organization that’s receptive to feedback, receptive to trying new strategies, and then also being able to publish this work and get it outside of our system,” Sumaya said.
Ryan agrees with the sentiment. “We have such strong, fierce support across HealthPartners and our leaders to continue on with this work,” he said.
Learn about the commitment HealthPartners has made to create a workplace where everyone is welcome, included and valued.
