About This Episode

Diversity expert and author, Lenora Billings-Harris, talks with Dr. Frank Maddux about racism and unintended bias in healthcare. Lenora was a keynote speaker for one of Fresenius Medical Care's Medical Office Live broadcast series on the same topic and talks about racism, unintended bias in healthcare, and how to have meaningful dialogue around these topics.

 

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Featured Guest: Lenora Billings-Harris

Lenora Billings-Harris is an award winning authority as a diversity strategist, researcher, and author. She has been included as one of 100 Global Thought Leaders on Diversity and Inclusion by The Society of Human Resource Management (SHRM), and was named by Diversity Woman Magazine as one of the Twenty Top Influential Diversity Leaders in the US. Her award winning diversity leadership research is recognized in academic journals internationally.

Lenora is the co-author of TRAILBLAZERS: How Top Business Leaders are Accelerating Results through Inclusion and Diversity, and she is often an expert guest on TV and radio internationally. She serves on the adjunct faculty of the business schools of Averett University and the University of North Carolina-Greensboro, and leads a full service diversity consulting firm. She has presented to audiences in over twenty countries on six continents including in the middle of the Atlantic and Pacific oceans.

She is a Certified Professional Speaker (CSP) and a Council of Peers Award of Excellence (CPAE) Speaker Hall of Fame inductee. She holds a Bachelor of Science degree from Hampton University and a Master of Arts in Adult Education from the University of Michigan. She has held key positions with General Motors and CIGNA Corp.


 

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Episode Transcript:

Dr. Maddux:
Lenora, thank you for joining me today in our dialogue series.

Dr. Lenora:
I am thrilled to be here. Thank you so much, Dr Maddux.

Dr. Maddux:
I thought I might start by asking you to just give us a little background on what you see is the distinctions between race and racism and those two particular terms.

Dr. Lenora:
That's a great place to start because so often, people do get this confused. The fact of the matter is that scientifically, there's no such thing as different races. We are far more alike than we are different, pretty much the only difference is the color of our skin from a scientific perspective. Race is a social construct that came about in the early 1600s in order for white people to create this body of thinking, so that they would be more superior so not just when Africans were enslaved and brought to America but even before then, in order that people could see slavery as holding people who are less than, they created this construct of race. Racism, however, clearly exists. Racism is about the actions people take based on their beliefs, so the biases, the prejudices etc that we have in our head, when we take action on them, then that becomes a racist act.

Dr. Maddux:
You were a teenager during the Civil Rights Movement, and can you describe a little bit about what today's protests look like to you in the context of the civil rights movement that you saw as a, as a young adult.

Dr. Lenora:
When I was 16, or so, is when the civil rights movement was already in place, but certainly when the protests started and the riots started it was a very scary time, and I'm from New Jersey so I was born in Newark, so I remember that vividly. The major difference though between what was happening then in the movement, not just the riots but in the movement versus today is that back then it was primarily black people, African Americans, that were protesting. There were a few white people, but mostly it was African American. Today, it is a rainbow, it is black and white, and, old and young, and as you watch some of the videos that are going viral on the Internet and on TV. These small children of all colors are asking questions about how they will be treated and how other people should be treated so it gives me hope this time, that they'll be more sustainable change.

Dr. Maddux:
When we ask you to complete this sentence: racism in the world today is________?

Dr. Lenora:
It is prevalent, and we don't want to think that we want to think that we're beyond that, but I've been fortunate to do this work of diversity, equity and inclusion and unconscious bias etc in over 40 countries at this point. And what I find is that there is at least bias, if not specific racist acts in every country that I have been to, and the fewer number of people of color, the more prevalent the racism is. And I think part of that is because people are just surrounding themselves with people like themselves so they see people as different as threatening.

Dr. Maddux:
We did a session at one of our medical office live events that you did a keynote speech around unconscious bias. I'm wondering if you can't give us a little bit of an update on your thinking about the relationship between unconscious bias and racism?

Dr. Lenora:
People are afraid to even talk about bias, let alone, racism, and I believe the reason is because they're so afraid they're going to say the wrong thing. That's one reason, and the other is because generally when we think of bias, we think all bias is bad. The fact of the matter is, as human beings, we can't not have bias. Bias helps us get through the day. So, all bias isn't bad i mean you can tell that I'm wearing a black top as we talk together today. Usually when I'm speaking and presenting I wear black and then I wear something colorful, that's my bias, I go towards that color because it's easy. So for me, that would be a good bias. However, we tend to think of those biases that label people. And we think that in and of itself is racism, it isn't. Racism is the steps you take, based on the biases  you might have so you may think, in this case, that African Americans are less, less than for whatever reason because you've been bombarded by the media, by movies you've seen, etc. But if you're not taking action on it, then that's, you're not a racist. It's a prejudice thought, but you're not taking action on it. Racism, though, is when you truly believe those thoughts, and you take action on them. Now some of the actions could be unconscious. A lot of them are conscious acts of superiority, and I think the more though that we can understand that bias is in our lives. It's certainly in the medical field, the more we can understand that it's there and become aware of it, the more we can disrupt those bias thoughts because the good news is our brains are not hard wired to be biased. We can, we can disrupt those neuron connectors, so that we can see people in a different light but it takes action to do that.

Dr. Maddux:
What do young people know about race and racism that older people do not? And then the converse. What do older people know about race and racism or think about it, that young people don't be interested in your perspectives on this?

Dr. Lenora:
The one area of focus that I'm asked to speak about beyond unconscious bias and racism and that kind of thing. Beyond that, the next most popular thing is generational diversity and generational bias, because in the workplace you know now there are four, sometimes five different generations. And what I know to be true is that young people see diversity and see difference different from older people, because they've been more exposed to people who are different. So they see the difference, for the most part, but they don't see it as a problem. And so they are more likely to notice when diversity doesn't exist. So we need to hear those voices because they have a different worldview they can see things that maybe some older people don't see. Conversely, older people can have the wisdom of their years. So, older people who have lived through the civil rights era, for example, regardless of whether they're black or white, they can have something to compare today to, so they can see that yes we've made some progress around systematic racism, for instance, but there's still a lot of work to be done, where a young person who doesn't have that perspective is wondering why can't we fix things immediately and why is it there in the first place. So the two, broadly speaking, the two generations, younger people and older people really need to value that difference and that's the essence of inclusion and diversity of thought is to hear it and listen, rather than immediately jump to judgment, which is what we tend to do.

Dr. Maddux:
Certaintly listening is a key part of it. I'd like to take your comment and think a little more about systematic racism and bring it back into healthcare just a little bit. So I'll start with an observation that I've had for several years on a variety of technical expert panels that I've sat on and at the National Quality Forum and other areas. Where it’s very clear that our federal government in its Medicare program, and some of its Medicaid programs has generally not incorporated into risk adjustment for quality measures the race geography or socioeconomic status and it's always been age and gender and comorbid disease and other things but never incorporated these elements and, to me, I thought that was a mistake. And I just would be interested, as an example, can you talk a little bit about the healthcare aspect of the sort of systematic potentially unconscious things that are embedded in our healthcare system?

Dr. Lenora:
Absolutely. And, and, as I answer it of course you know I'm not a healthcare professional, but I've worked a great deal with various healthcare systems in helping all of the professionals to better understand how biases impact their work. I find it quite astounding that these government agencies are intentionally overlooking the disparity that there is because of systematic racism because we know that people of color, and particularly African Americans do not get the same level of health care that others do. And some of that is because of having access to it, but even beyond that, when an African American person comes to a healthcare facility and is talking to the intake person, to the nurse, and to the doctor, they are human beings and so all of those professionals, turn on their biases, not intentionally, I hope, but they do turn on their biases so that there is clearly research that tells us that there is disparate treatment for diabetes, for heart disease, for almost everything that people may suffer from. And one of the research studies I believe this one was from University of Michigan. One of the research studies identifies that black people are assumed to be able to sustain pain better than white people so they don't believe us when they ask us on a scale of one to 10, what's the pain if we say nine, they're not equating it is what nine would mean to them. So there's that disparity there. Additionally, if an overweight person of color calls on a doctor, or is in the emergency room, what research is also telling us that is that the doctors do not assume that this patient will follow their direction, take the medication and do the other things in order to take care of themselves whether again if it's a heart attack or diabetes or strokes or any of those kind of things. And so they don't prescribe in the same way that they do to white patients, I'd like to believe that that is very unconscious, because I know how much we're bombarded by inaccurate information about black people versus white people in healthcare. My work however, as I've worked with different medical systems is that it isn't always unintentional.

Dr. Maddux:
So let's think about open, honest dialogue for a minute because I think in the healthcare arena, we need to engage in using tools that we have to have more honest dialogue about this, this topic, and you have previously talked a little bit about honest dialogue and the use of tact as a, as a technique to try to keep people from being fully defensive when they get into these complicated conversations, can you describe this a little bit for us?

Dr. Lenora:
Thank you for asking and because that's, that's one of the questions I'm being asked frequently. White people are saying to me, and these are my white colleagues as well as clients etc is “I do care about this and I want to know more, but I'm afraid to say anything, for fear of saying the wrong thing.” Well, the fact of the matter is, there is no book that can tell you all the politically correct terms. We're going to make mistakes. I've been doing work in this space for 25 years and I've been in business for 34. And still, even though I live and breathe this every once in a while I open mouth and insert foot. So my recommendation is what I invite you to do is to be tactful, you can be tactful and honest at the same time. So you can speak what you're thinking, and especially if you're talking one on one, be able to, I encourage you to say to the person you're talking to, you know, I've got a question, you may think it's a dumb one, but I honestly want to know, I really want to know. And then ask the question. Now, don't assume that in this case every black person is going to want to answer every question, because some people are just tired, and you need to respect that. On the other hand, there are many of us that say please ask because when you don't ask, silence is not acceptable. When you don't ask you rely on your biases you rely on your assumptions. So lean into that discomfort, and you're not going to get the same answer from everyone. The question I get asked most often so I'll share it with you is well. “nowadays, should I, if I have to use a term should I say African American or should I say black?” Well, my answer is yes. Meaning, sometimes black is more appropriate, sometimes African American is. Black is most appropriate informally, but you know it nobody, nobody much is going to be offended. And also if you're not sure the people you're talking to are all African American they could be black from the Caribbean, or from Europe. On the other hand, there are some black folk that don't like being called black, and here's the reason why. When you read most publications, newspapers and magazines. If they are talking about a black person, and we know they're speaking ethnically, they don't capitalize the B. Now they don't capitalize the white either but there's a choice that you could say American or you could say, Italian American etc. And so some black people say, call me African American, because when you write that you have to capitalize the two A's, so it's a matter of dignity and respect. Again though, the question is to ask people that you're interacting with, they'll give you their answer, it won't be the absolute answer.

Dr. Maddux:
What do you think the state of racism will be like and 50 years from now, what, what do you think the opportunities are here.

Dr. Lenora:
Well, what's statistics tell us is that the demographics are changing rapidly, and so well before 50 years from now, the demographics will be such that people that we call minorities, I prefer to call them underrepresented groups in the workplace. They will be the majority. And therein lies the fear, by the way, for many white people because they feel they're afraid that they're going to lose power. However, 50 years from now, we will look different and more people will be like young people today where they will see difference, but they won't see it as a problem. What my hope is, is that we will have eradicated enough structural racism, those systems that intentionally hold people down, we will have eradicated enough of that, that we'll be talking about racism from a historic perspective. That's my aspirational hope.

Dr. Maddux:
Individually, organizationally and, and certainly as a society, so much of the conversation around racism is inhibited by fear. And I'm just curious on what sort of tools and techniques, do you think we can all use and think about to try to reduce the level of fear, so we actually get to those honest conversations and dialogue that needs to occur. 

Dr. Lenora:
A couple of things. One is we fear that which we do not understand. That's just a natural tendency in our limbic system, the nervous system connecting to our brains are trying to just keep us alive and so if we see a person that we don't understand or who's very different from us, we can automatically be fearful, that's an emotional reaction. So one of the things we need to do is to learn more about people different than us, and intentionally surround ourselves with people different than us because the reason we are fearful, is because as human beings, all of us want to belong. It is now being found that that is the most primary need of human beings. It used to be that we thought food and water was the most primary need, but we're now discovering that that belonging, connecting is the most primal need that we have. So, we tend to belong to groups that are people just like us. The more we can be surrounded by people who are different than us, not just in skin color but in all other types of ways, the more it broadens our perspective, and most importantly, the more it enables us to have diversity of thought, so that we don't rely on those emotional bias thoughts that will pop into our head automatically.

Dr. Maddux:
The death of George Floyd, and others has sparked responses from all over the world, and a very global movement that seems to be occurring right now. Is this surprising to you the outpouring that's occurred and just any thoughts or comments, as we close this particular dialogue session on just the aspect of this representing all of us as humans and not simply just the US population?

Dr. Lenora:
Yes, I was pleasantly surprised to see the protesters and then demonstrations around the world. And I think that's an example though of knowing that racism is not just in the United States that that everyone wants to feel equal and to have dignity. I do believe though that people are looking for action. So we want to talk about it. We need to have safe places in the workplace where folks can come together whatever color they are, and ask the questions and hear and really listen, and that needs to happen all over the world. There's also newspaper articles about black people in Ireland and how much they're protesting. So we need to recognize that the bottom line is that we are all connected. We truly are all connected. And I think that one of the reasons it has happened the way it has happened now is because we were in the midst of a pandemic. So people were watching the news and social media, even more than they normally do. So when they saw George Floyd be murdered and watched the entire thing. It is very difficult, it became very difficult for even people who may not want to know these things or see these things. It was very difficult to say, well it was because he was being a bad person. It was because he was running away because he was already handcuffed, so you can't turn away from that. And I think more people realized they needed to do something.

Dr. Maddux:
Any closing thoughts or from before we finished the interview here.

Dr. Lenora:
So I’d like to leave you with a very easy pneumonic that can help you individually, as well as as an organization, and it's “B basic.” The first B stands for “breathe” realize you're going to make mistakes. That's how we learn. So just breathe, calm yourself down. The second B stands for, “Be willing to be the other.” Surround yourself with people different than you in lots of ways. Dinner parties, whatever it is, be willing to be different. The A stands for “ask questions.” Listen, empathically, and ask questions. The S stands for “suspend judgment.” When you realize you're having that bias thought to say thank you very much. Move aside. Let me see what the reality is right now in front of me. So, suspend judgment. The I is to invite others, invite others to be in your space, invite others to be on your teams that are different than you, so that you can hear their perspectives, and the C of B basic is the hardest one, which is “check your ego at the door.” Because as leaders, We have learned how to make decisions fast. We need to slow down. Listen, and see if there's another perspective.