2023 | Volume 24 | Issue 2

Without belonging diversity and inclusion is tokenistic

Without belonging diversity and inclusion is tokenistic
Authors: Dr Maxine Ronald, Dr Sarah Rennie, and Professor Spencer Beasley
There is a lot of talk within RACS about diversity and inclusion.

RACS has a diversity and inclusion plan that is currently being updated, which indicates RACS is ‘leading the way towards inclusive participation in the practice of surgery and life of the College.’ Quite a few targets and timelines have been set, not all of which have been achieved. Within surgery, our focus for diversity and inclusion initially has been around gender and ethnicity—particularly ensuring representation of our Indigenous peoples. But diversity and inclusion in healthcare may also include other underrepresented groups including culture, disability, sexuality, socioeconomic status, rurality, and age. 

Our training system and healthcare systems are primarily based on western systems that have been generally developed by privileged, heterosexual, able-bodied white men. Consequently, we cannot assume that all those coming into this system from under-represented groups are going to feel safe or have a sense of belonging. Trainees from under-represented groups often have a different world view from that entrenched in the established training systems. This can make navigating the current training systems and surgical organisations more challenging and stressful for them and may lead to a feeling of not belonging.  This can be further compounded by a system that appears to accept people from diverse backgrounds—but only if they then conform to the norm. In essence, if they reject some of the very qualities for which they were selected. It is possible to be included, yet still not belong or to be able to effect change. 

The risk of diversity and inclusion initiatives that simply focus on increasing Trainee numbers from under-represented groups to meet targets is tokenistic.  
To be genuine it should be accompanied by a willingness of institutions to accept the value of diverse opinions and undergo transformational change, and therefore benefit from diversity. This can be a very uncomfortable space to be in because it requires institutions to be willing to change and relinquish influence on those who have previously been considered ‘others’. 

Similarly, diversity of selection alone is inadequate unless it is accompanied by a training program and working environment, which fosters both inclusion and belonging. To be most effective, institutions themselves not only need to change, but also to actively embrace change.

How should we judge who are our best future Trainees?  What criteria do we use to assess them? The criteria for selection should be oriented to elevate the traits, skills and values that esteems candidates who reflect the communities we serve, and in this way prioritise diversity.

We need to ask ourselves whether our generally rigid inflexible systems that work to meld the individual to fit into our current perceptions of the ‘best surgeon’ really encourage belonging and the potential of diversity? One of the arguments we hear is that we need to pick the best person for the role—but who judges this? What criteria do we use to assess this? 

Often—unless we consider not just how to ensure diversity and inclusion but also how we can achieve empowerment and belonging—we are unlikely to see who these ‘best’ people are. A strong feeling of belonging would enable views, beliefs, and values of everyone to be heard and respected, and to become influential within our College. 

There is now plenty of evidence that health disparities for our patients relate to Indigenous background; some directly relate to unconscious or conscious biases held by healthcare professionals. We also have evidence that patient outcomes improve if they are cared for by someone who is like them (that they feel more comfortable with) in terms of gender or ethnicity.

Effective diversity initiatives will reflect both the communities they serve and will empower people from diverse backgrounds to influence policy and strategy. Empowerment, however, is most effective when there is belonging. Belonging needs to be experienced by diverse groups: the corollary being that the predominant group needs to accept the need to change. A sense of belonging for all will enable our College to become stronger and better, and ultimately, help provide better health outcomes for all our patients.