Let me tell you a joke. Two humans walked into a bar. The third one ducked.
Which one are you?
The first two humans walked into the bar because they were not conscious of their surroundings. They were not aware of the dangers in front of them. Some of you may feel like you just walked into a bar due to the social tensions in America. You may feel like you don’t know what everyone’s arguing about, or why people are upset—or maybe you thought the situation wasn’t that bad. You may have even voiced your thoughts in a public space, only to be met by a negative response. You may have been “cancelled” by a family member, friend, or peer. That’s because the bar of social injustice is long and wide, and we are living in a historic moment where people are demanding its removal.
How will you engage in the fight for social justice?
Social justice requires equal access to privileges—like wealth or various opportunities—within a community or society. Without equal access to privileges, social injustices flourish until inequities appear everywhere—in education; housing; health care quality; distribution of wealth, violence, and policing; and other social staples in the world. But different opinions about social justice—what it is and how to achieve it—divide our country and our profession. The death of George Floyd and other recent events have forced us to enter a season of increased discussion and conflict around social injustices. We will have to make big decisions regardless of our individual stance. The decision to support or to not support the movement. The decision to engage conversations or not to engage.
If you choose to stay neutral, that decision will be judged by your peers, your friends, and the communities you serve—and often, neutrality is viewed as conscious, subconscious, or unconscious support of social injustice. You are the third human who ducked. You are aware enough to know that there is a problem, but you ducked the issue.
But you are a physical therapist, rehabilitation provider, or a business owner. You do not have the luxury of ducking, because you have entered into a healthcare partnership with your community—often with marginalized communities. Our industry works with communities that suffer the most from chronic disease and disability, and these mutualistic partnerships are extremely vulnerable during social crises. You have already recognized the bar—the problem—and you’re bound by an obligation to either ignore or help solve it.
How will you protect marginalized communities?
Patients who engage in a partnership with you will require a response to the current historic moment. In the absence of a response, whispers of social injustice and health inequity will wind through your clinic’s waiting rooms and staff areas, and in your satisfaction surveys and staff productivity and retention data.
We’ve seen the consequences of silence in academia. Silence breeds distrust. Distrust destroys the sense of community within and beyond the walls of your clinic. How will you protect your partnership with marginalized communities? How will you protect your most valuable asset—your connections and relationships with your patients and staff?
1. Acknowledge your risk areas.
Risk and risk management are a foundational part of the business experience, and risk related to social injustice requires you to have crucial conversations with your staff. You must honestly assess your organizational values and beliefs, and establish cultural norms that are agreed upon by all—not just your leadership team. New cultural norms that are determined by those in power are seldom effective when building a healthy work environment. Effectively setting new cultural norms requires collaboration and universal buy-in. But if you create that cohesive work community, then you will ensure the highest levels of operational continuity and team health and wellness—even during times of social crisis.
2. Know your community.
Start by asking yourself what you truly know about your staff. Can you identify their many layers based on the dimensions of the Loden and Rosener diversity wheel? What are your staff members’ pain points? How have they been (or how are they currently) marginalized? Make an effort to ask these questions, because unaddressed or ignored pain heightens during times of social crisis. This can be a risk or an opportunity for business owners and leaders. Have you expressed sympathy or empathy for your staff who are hurting?
Offer support for non-marginalized groups, too. During times of social crisis, there is often collective grief, pain, and loss. People hurt on all sides of the crisis—and therefore, everyone is vulnerable during a crisis. Have you also reflected on what your staff knows about you? If you asked your staff to state your values and beliefs about the current social crises, what would they say? Remember, you are part of the community, too—and you should express your voice and life experiences.
But, this is not the time to speak for anyone else. Speak as an individual and a fellow community member. It is not your responsibility to speak to another person’s experience. Instead, listen and respond with your personal truth—and lead through truth and vulnerability.
Seek more knowledge.
Think about your community more broadly. What do you know about the vulnerabilities of the communities you serve? Have you researched and identified the social vulnerabilities and health outcomes at your state, county, city, and zip code level? Consider the benefits of a community advisory council to determine the needs of your community and how you can meet them. Remember that many rehabilitation clinics are not located directly in the areas of greatest need, so you should seek advice from a diverse group of community members.
3. Prepare your response.
You must respond to these crises. Do not duck. Even if you do not support some actions that your community takes, you can acknowledge their pain. After all, everyone wants to be seen and heard. I often tell people that the truth is in the middle. However, the middle requires two opposing ends, and those ends must speak their truths. You cannot afford to not respond—and it’s not really a neutral option, either. Ducking the issue is still a response, and it tells people that you’re willing to ignore them or their lived experiences.
4. Prioritize transparency.
We all need honesty right now, but honesty is not meanness. When you speak your truth, be clear, but speak with kindness. Remember that clarity requires that you work on yourself—which means you must educate yourself on the issue, ask yourself why you believe what you believe, and challenge the story you tell yourself. We have all been marginalized at one time or another in our lives. We all know when we are being lied to—either directly or indirectly. Don’t waste your time or others’ time with a lie. The community deserves to know who you are and where you stand so they can make an informed decision about entering or remaining in a partnership with you. Speak your truth with love and kindness, and we can all try to grow together.
5. Stay true to your response.
Regardless of how you respond to the current social crises, take an action—something that aligns with your authentic response (and preferably something you can measure). For example, try:
- hosting staff focus groups to discuss your workplace culture;
- hosting community town hall meetings;
- analyzing your vendor relationships and finding opportunities to diversify; or
- inspecting your policies and procedures for biases against staff or customers.
Consider offering regular perspectives or impact reports to staff and the communities you serve. This effort will improve employee trust, satisfaction, and retention. You will also solidify your brand in the community.
It’s time to be courageous. Be the fourth person—the person who removes the bar of social injustices. Be the person who understands that injustice for one is injustice for all. If you are not ready for that conversation, consider this fact: the economic impact of health inequities (a social justice issue) annually costs taxpayers between $54 and $61 billion. As you review your accounts receivables, think about the potential benefits to your bottom line if customers had the resources to pay their co-pays and deductibles—or if payers could improve reimbursement rates. Correcting social injustices, regardless of your motivations, will affect everyone. Remember, a rising tide lifts all boats.
Are you ready to lift that bar out of the way?
In solidarity as a fellow human,
Lisa VanHoose, PT, PhD, MPH
