Survey methodology

For the survey, the Commonwealth Fund and AARC conducted both qualitative and quantitative research. In November and December 2022, AARC conducted six focus groups with healthcare workers, including one group for each of the following:

• Employees in community health clinics
• Employees in hospitals
• Black healthcare workers
• Latino healthcare workers
• White healthcare workers
• Immigrant healthcare workers

While AARC didn't conduct a specific group for Asian American/Pacific Islander (AAPI) healthcare workers, AAPI healthcare workers did participate in the clinic, hospital, and immigrant focus groups.

Then, between March 14 and April 5, 2023, AARC conducted a survey of 3,000 healthcare workers employed at hospitals, outpatient facilities, long-term care, private practice, addiction and mental health services facilities, and community clinics across the United States.

There were 26 job titles included in the survey, including nurses, doctors, licensed practical nurses, dentists, medical assistants, dental hygienists, physician assistants, mental health workers, and administrators. The survey oversampled Black, Latino, and AAPI healthcare workers, however, according to the Commonwealth Fund, the survey also had "a robust sample" of white healthcare workers.

Key findings

The survey found that more than half of healthcare workers said that discrimination based on race or ethnicity against patients is either a crisis or a major problem. Black and Latino healthcare workers were more likely to say racism against patients is a crisis than white or AAPI healthcare workers.

How big an issue racial and ethnic discrimination against patients is also varied by which types of patients workers interacted with and where they worked, the survey found.

For example, 68% of mental healthcare workers said racism is a major problem or crisis compared to 52% of the healthcare workforce as a whole. Meanwhile, 63% of healthcare workers in community-based facilities like health centers of school clinics said racism against patients is a crisis or major problem, compared to 51% of workers in long-term care facilities, 47% in outpatient facilities, and 55% in hospitals.

In addition, 79% of healthcare workers in facilities with majority-Black patients and 66% of workers in facilities with majority-Latino patients said racism against patients is a crisis or a major problem. That compares to 52% of workers in facilities with a majority of white patients and 47% in facilities with no racial or ethnic majority among patients.

Meanwhile, half of respondents agreed that patients of color are treated differently than white patients and are less likely to receive medication when seeking treatment for pain. In addition, 57% of healthcare workers said patients who speak a language other than English don't always receive the same quality of treatment as patients who speak English.

The survey also found that the likelihood of experiencing stress related to racism varied by healthcare workers' race. For example, 27% of Latino healthcare workers and 23% of Black healthcare workers said dealing with racism or discrimination based on race or ethnicity creates "a lot of stress" compared to just 16% of AAPI healthcare workers and 12% of white healthcare workers.

Discussion

Henry Fernandez, CEO of the AARC and lead author on the report, said the survey results "shin[e] a light on the discrimination and racism health care workers observe and the implications for negative health outcomes of patients in many communities."

"Understanding this connection at a national level is critical to measuring and addressing discrimination in the health care system to mitigate harm to patients and produce better health outcomes overall," he added.

Laurie Zephyrin, a SVP for advancing health equity at the Commonwealth Fund and a co-author of the report, said, "It is something that needs to be addressed. It is something that not only affects patients but also affects health care workers. It creates stress."

The report made several recommendations to address racism and discrimination against patients, including:

• Providing an easy way for patients and staff to anonymously report situations involving racism or discrimination
• Examining policies to ensure they result in equitable outcomes
• Requiring classes on discrimination at professional schools
• Creating opportunities to listen to patients and healthcare professionals of color
• Examining the treatment of non-English-speaking patients
• Training healthcare staff to spot discrimination

Advisory Board resources on addressing racism and discrimination

Advisory Board has a variety of resources on addressing racism and discrimination against patients, including this cheat sheet, which shows how health disparities at the point of care can negatively impact patients and health systems and offers conversations you should be having to address these disparities.

In addition, this resource recommends organizations adopt a culture humility model, which better positions organizations to have a significant impact on building trust, supporting patients' engagement in their care, and improving outcomes. (Fernandez et. al., Commonwealth Fund report, 2/15; Alltucker, USA Today, 2/15; U.S. News & World Report, 2/15)

Download our cheat sheet to learn how health disparities at the point of care can negatively impact patients and health systems.