Equality, Diversity and Inclusion

An inspiring and honest conversation about equality, diversity, and inclusion between senior lead for inclusion NHS leadership academy, Yvonne Coghill, and former head of practice, David Ashton. They cover the areas of ‘otherness’, white privilege and how becoming more understanding has helped relationships and collaboration.

Key topics including difference, the right interventions to help people recognise this and weathering (the stress from the impact of your race – the impact of the stress has on your physical and mental health – it’s like having to wear a metaphorical suite of armour every time you go out to attempt to receive the same conditions as someone different to yourself).

In England 18% of the workforce in the NHS are BAME so this weathering effect is impacting on them, their families, and their patients.

Think abut the stress on your workforce when watching this video and ask yourself if you are aware of what is really going on for the different populations you are working with. Those you are being ‘paid to smile’ which is what is discussed and how this can play out in both the heath and social care setting.

Yvonne Coghill (00:08):
“My name is Yvonne Coghill and I am the senior program lead for inclusion and coaching in the Leadership Academy.”

Dave Ashton (00:14):
“And my name is Dave Ashton, and I’m head of practice here at the Leadership Academy.”

Yvonne Coghill (00:17):
“Inclusion, equality, diversity, fairness, agenda, call it what you like, is complex. And I think that people imagine that’s an easy tick box thing, so where we’ll do inclusion and tick the box and then everything will be okay.”

Dave Ashton (00:34):
“We’ve not worked together long. We went to the same meeting, so I’m not naming names, but someone saying to me, “Whatever you do, it won’t be right.” It will be wrong. You will make a change here. You’ll put something in place there, and it’ll be fine for one group, and it won’t be okay for another group. That is difficult. And I’ve seen that as well in practice. So if I watch a TV program, I’m now constantly looking how diverse is the mix of people here? How obvious is the difference in the room? And just how hard it is just being other.”

Dave Ashton (01:09):
“Apparently there’s a trendy term at the minute called otherness, and how otherness is represented. And being a white middle aged guy, I have it easier. Much easier in many ways.”

Yvonne Coghill (01:21):
“Your point is absolutely right, and well-made. Because I don’t think people recognize or realize that some people, just by being born white middle class, it affords you a certain amount of entitlement and privilege that other groups don’t get. I’ve learned to become more understanding of people coming from a different place to me. Because I used to believe, why couldn’t they see it? Why can’t people see the difference is important and why don’t these white people get their act together and start behaving differently? Well, why would they?”

Yvonne Coghill (02:00):
“If you are coming from a place where you were born where there’s mostly white people, you’ve been to school with mostly white people, you’ve just gone up through the ranks and there’s been no issues for you, you haven’t had the experience of the difficulties that some groups have. So then what we start to ask people to do is to think about being empathetic and understanding. And for them, it’s kind of like, “Well, why? Why would I?” But I think for us in health, it’s important that people grasp that and grasp the things that you’ve grasped around difference, and how people are coming from different places. Subsequently they need different interventions. Because in order to make our society fair, we have to do different things for different groups of people.”

Dave Ashton (02:51):
“You’ve talked to me about weathering for folks from a BME background, that it’s just harder day on day. Living life because you have to put on your armor.”

Yvonne Coghill (03:01):
“You’re absolutely right. And it is wearing. And I think the weathering thing, which was something I found out about recently when I went over to America and met the wonderful Dr. David Williams, and the work was done by this woman called Arlene Geronimus. She did a lot of work on women in America who were just ordinary women, black and white, having babies.”

Yvonne Coghill (03:21):
“And what she found was, regardless, and I thought this was absolutely fascinating, regardless of whether they were middle class black women or working class white women, the middle class black women were more likely to lose their babies than working class. Because in our heads, we think that the more prosperous you are, the more educated you are, the better life will be for you is what we automatically think about. But what she was finding was that wasn’t the case at all. And the most educated black woman still was more likely to actually have her baby die than a white woman, who was not educated and came from very poor background. And what she did was she actually looked at what they called all the factors that could possibly, or potentially make that difference. And taking them all to one side, the only difference was race. That was the only difference.”

Yvonne Coghill (04:17):
“So she looked into a little bit more to find out exactly what was going on, and what she found was that women from black and minority, ethnic backgrounds and particularly ones going up the ladder had to do the thing that you said, which is to put your arm around every time you go out. So age wasn’t only capturing the length of time they were alive. It was capturing the experiences they’d had within that time. And if those experiences were difficult and hard and they had to take a deep breath to go into rooms where there’s only middle class white men, or you can’t go to the public lunchtime because you don’t know how people are going to treat you, or you believe that your children are going out to school, and you have to worry about the fact that they might be shot or picked up by the police or frisked or whatever it is. Those experiences are causing you increased stress, and that increased stress weathers your body physically and mentally.”

Yvonne Coghill (05:09):
“So you’re more likely as a black person to have mental health problems, you’re more likely to get diabetes and coronary heart disease. You’re more likely to die sooner than the white person. And on top of all of that, if you have to deal with then the likelihood that you’re less likely to get a job, you’re less likely to actually be sent on training and development programs. You’re less likely over your lifetime to earn an amount of money that the white person would, put that on top of all the other experiences that I’ve just described. You can see where this weathering thing comes from and how it is that it impacts on people’s health.”

Yvonne Coghill (05:50):
“So when we talk about health inequalities, we’re talking about usually in the NHS, we’re talking about people out there. We’re talking about the communities. What we tend not to do is recognize that the members of our staff come from those communities and are living within those communities. So the weathering that’s happening out there for them, it’s actually happening for those members of staff. And we have 18% of our 1.4 million workforce from black and minority ethnic backgrounds. It’s happening to them as well.”

Dave Ashton (06:25):
“There’s another bit of work by someone, another American, Ali Hauschild. And she wrote a book back in the 80’s I think it was. After that, I’ll look it up again. The book’s called The Managed Heart, and that’s all about the emotional impact or the emotional cost of working in an emotional setting. So they hosted a group where I think there were airline staff and also people that worked on the shop front, that they were paid to put on a smile and be polite when actually they were struggling inside. And it’s a paid to task, and so even more so when it’s working with sentient beings. So if you’re in health care, if your struggling in life and you’re getting more knock backs, and you’re being asked to look after people and that’s part of your job to give good care, there’s a cost and there’s a cost for staff, and there’s a cost for people that receive care.”

Dave Ashton (07:22):
“And it’s how we pay attention to that through, I guess our leaders being aware of the dynamics that are out there. And I think that’s part of the Academy’s role is bringing that awareness powerfully and skillfully into the programs that we deliver. Because if the leaders don’t get that, don’t get this as an important aspect of day to day life, not only at work, it’s a societal … You mentioned already, it’s a societal thing as well, then we’re losing out and patient care won’t be as good as it could be.”

Yvonne Coghill (07:54):
“I think it’s absolutely right. And I think for us in the leadership Academy, it’s all about healthcare and having leaders that can deliver that healthcare, and understanding some of the things that you and I have talked about here this morning. So for example, understanding and knowing that the link between an engaged workforce, some of the work that Mike West has shared with us, and Jeremy Dawson, understanding that having an engaged workforce, people that really want to go to work that feel motivated, that feel part of something, gives them a little bit of a lift. So when they’re working with patients, the patients feel that. There’s an emotional connection. So as a nurse or a doctor, you’re more willing to go the extra mile because you’re cared for, you care more.”

Dave Ashton (08:38):
“Yeah. It’s this notion of emotional contagion. So if I rock up to work and I’m not feeling good, however hard I try, that would affect other people, affect other colleagues and patients and carers. It spreads.”

Yvonne Coghill (08:52):
“I think so. And I think this … It’s a real health issue. It’s a societal issue. It’s a human issue that we’re dealing with here. And that’s the complexity of the thing. And so the fact that you understand and get that, so the work that we’re doing supporting our senior leaders to get that. So that’s putting some grit in the oyster and actually some of the things that we’ve been doing, the videos we’ve been showing people, the discussions we’ve been having have actually shocked a few people because it hasn’t been part of their consciousness. But what do they do? They immediately switch onto it and say, “Well, yeah. I haven’t been paying attention to this. I need to pay attention to it.”

Yvonne Coghill (09:33):
“So one example was one of the people from Top Leaders actually left the room and went and made a phone call to find out exactly what was going on in their organization around inclusion. Another one said that when they went back to their organization, they actually stopped and asked some people in the corridor, “How does it feel for you to work here? Their consciousness was switched on by understanding that this is something that they can … They need to do something about, but sometimes people just don’t know what to do or how to go about doing it, or they don’t have the background understanding.”

Dave Ashton (10:06):
“Yeah. I think that’s a key point. It’s how you make it, create conditions that are safe enough for people to have honest conversations that, “I don’t know what it’s like to be disabled. I don’t know the challenges someone might face.” And sometimes we inquire into that. I’ve caught myself, even though I’m a nurse by background, it’s different when I’ve had a nurse’s uniform doing that, compared to when I’ve been in a leadership role, or a formal leadership managerial role. It’s a different set of skills of bringing it into the conversation. And sometimes it feels really clunky, but not to do it, it’s not right not to do it. But people need the skills. And as I say, they need help in feeling safe enough to have some of those conversations.”

Dave Ashton (10:50):
“Some of the conversations we’ve had about what it’s like for you as a black woman, I wouldn’t have when many people. And we need time to have those conversations. It’s not something you can do just in an odd five minutes here and there. You need to sit down with people and talk about what it’s like. What is it like in your world?”

Yvonne Coghill (11:12):
“That brings me full circle to the leadership issue really. And having leaders like you from white middle class backgrounds who are switched onto the agenda. Who are willing to say, “I don’t know. Help me. Let’s work on this together,” so that we can have a workforce, a senior leadership workforce that does get it and does understand it. Because ultimately it will be beneficial to our patients, but also it will be beneficial to all of our staff. In doing that as one of the biggest organizations in the world, we have a responsibility to do this right, and to do it well for all of our staff, but more than that, for our patients. And in an increasingly diverse UK, Britain, it’s something that we have to really pay attention to and we haven’t in the past.”

Yvonne Coghill (12:03):
“So we need to think about, we’ve got people from different parts of the world, living here. We have people from different parts of the world actually being sick here. How are we going to make sure that they get what they need? They deserve, the service that they need and deserve from our health service. And that is through leaders understanding their needs and designing and developing services for their needs, but using their workforce in a way that’s appropriate and right. So their workforce feels engaged, motivated, switched on, and part of what’s going on for their patients. So it’s an iterative circle.”

Yvonne Coghill (12:40):
“So we start with, in the Academy, senior leaders. And trying to get our senior leaders to understand the thing that we understand, which is that this isn’t about beating people up or saying, “You’re not doing this, and you have to do that. It’s about ensuring that everybody, as part of our constitution, gets high quality patient care when they enter our services, regardless of their background and regardless of where they’ve come from in life.”

Try these web resources to find out more:

• Person Centred Care
• Developing People
• Leadership Styles for Care Managers

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