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The past year has been marred by loss. We have lost our usual routines, access to the people and experiences that make us feel like ourselves and the freedom to make certain plans.

Though we have all been affected by the pandemic, we have not all been affected equally. The pandemic has further exposed existing health inequalities and long-existing issues around race within the health care system, highlighted in the NHS staff survey released today  – including higher rates of bullying and harassment and less visibility at leadership level among Black and Minority Ethnic (BAME) NHS staff. The racial uprising that grew out of the death of George Floyd has also undeniably influenced conversations we’ve had about race and racism.

A discussion on racial inequality in health care

It felt important that Q’s annual event in November should meaningfully acknowledge these issues and explore the role we, and improvement, can play in addressing them.

Though we have all been affected by the pandemic, we have not all been affected equally.

We held a fishbowl discussion between a small panel of Q members, followed by individual and group reflection and a Q&A with the panel. The session provided a platform for Q members to share their experiences of operating in a health system which includes structural racism, as well as how to challenge this through improvement work. We used principles from Team Time, developed by the Point of Care Foundation, to create a safe and intimate space to explore the subject.

In the lead up to the session, I wondered how it would feel for all participants, especially the panel members of colour who showed immense courage and generosity of spirit in sharing their experiences. The mere act of being in the session required everyone to connect with a certain vulnerability and, in doing so, our personal and professional selves had to coexist in a striking way.

Through the panel discussion and group reflection, six key questions emerged:

  • What does great allyship look like?
  • How can a growing awareness of racism be shared with others who may be less willing to engage?
  • What has been my role in perpetuating racism?
  • What practical actions can we take to support change?
  • How do we ensure the intersections of race are acknowledged?
  • What has delayed improvement work addressing racial inequity?

Finding answers to these questions, particularly the last, is challenging. It requires ongoing collective exploration and a willingness to not be the expert, to be vulnerable and to acknowledge where improvement has fallen short. In the Q team, we have spent time since reflecting on what we heard. We’ve considered how to take the work forward before sharing back with you all now.

Starting by looking within the workforce

We heard that there is a need for open conversations within workforces about the experiences of BAME staff and this is an essential first step. This begins with committing time and resource into educating teams and putting in place systems that support staff adequately; systems that not only celebrate but respect difference.

What conversations are being had in team meetings and what conversations aren’t?

We heard that we cannot ignore how the professional and personal intersect. As Will, a junior doctor, shared in a recent audio project by the Empathy Museum (made with the support of the Heath Foundation and others) his experience of being stopped by the police on his way to work is connected to and affects his experience at work. His story is just one example of what staff members of colour can carry into their work lives and why there is a need to ensure experiences are sufficiently understood and supported.

Greater racial equity starts with a willingness to engage in personal enquiry and to challenge the unconscious biases that prevent vigilance, cause perpetual damage and limit compassion. What conversations are being had in team meetings and what conversations aren’t? Who asks the questions and who answers them? Are people of colour given, and giving themselves, permission to prioritise their wellbeing and is the emotional load of contributing to this work recognised?

If teams can make the time to acknowledge the different experiences of individuals within their workforce, who they are away from work, the pressures that impact them professionally, and their different preferences and support needs, they go some way in making a change.

What steps is Q taking?

We have just as far to go in becoming more inclusive and informed as any other team. We are planning internal training so that the Q team better understands issues about race and can confidently address inequality in our work. We will also be reviewing member data and experiences to understand how to support diversity and inclusion more widely in the community. This will take time and require everyone in the team to be honest and willing to establish new approaches and ways of thinking.

Sessions like the one we held at the event allow us to hear directly from members and we want to keep learning from you. Please get in touch with your thoughts or, if you’re doing work in this area, consider sharing it with the community through a blog.

Whilst the session was not recorded, we did capture the thoughts of the panel in this video. I encourage you to watch and see what resonates, challenges and ultimately motivates you to make a necessary change.

I started this blog talking about what has been lost in this past year but there was much that was gained. We gained clarity, courage and accountability. We all deserve to live in ways that better honour our humanity and are founded in fairness, and I hope you’ll join the Q team in considering how we can all take steps towards that.


  1. I am in, Tarnia and would love to come together with other members in Q to shape our interaction in supportive and opportunity-focused creative ways. I have recently been reading about the weathering hypothesis which states that chronic exposure to social and economic disadvantage leads to accelerated decline in physical health outcomes and could partially explain racial disparities in a wide array of health conditions. Whilst we need to be supportive of those who will share their lived experiences because this is very hard to do, I sense that this needs to be combined with applying our creativity to spot and act on opportunities in order to give us the energy to move forward.

    1. I agree, identifying opportunities to take action is essential in bringing about change and I’m also excited to see how we can work alongside members to do so. Thank you for reading!

  2. Guest

    Hesham Abdalla 1 year, 2 months ago

    Thank you for sensitively hosting an amazing session and your reflections since, bringing this taboo topic into the domain of Quality Improvement.

    he 2020 NHS staff survey came out this week, bringing the focus back onto people and culture in trusts. This shows that 13.1% of staff reported experiencing discrimination at work, with ethnic background mentioned by 48.2% (!) of staff who felt discriminated.

    At a personal level, I'm proud of the difference Hexitime is making in collaboration with the Shuri Network to promote women of colour in digital health.

    We need institutions that enable people to help people; to allow them to think big and act small.

    1. We remain so grateful to you for participating in the conversation, Hesham; your reflections were valuable and I agree, the NHS Staff Survey highlights extremely challenging issues pertaining to race at work remain and will continue to without steps being taken to address them.

      I love how you articulate how we collectively make change, thinking big and acting small is effective - it makes what is an incredibly complex subject feel accessible and offers us all the opportunity to contribute in manageable but meaningful ways.

      Hexitime’s collaboration with the Shuri network is exciting and I very much look forward to seeing how this work develops.

      Thank you for reading!


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