Equality, Diversity & Simulation

I attended a three-hour equality and diversity (E&D) workshop this week. I would like to say that this was because I have a real interest in E&D. However my reason for attending was as a requirement for my position as centre director (and hence job interviewer). I had mentally prepared myself for a tedious, mind-numbing session and physically prepared myself by having a double shot of coffee in my mocha.

And  yes, there, as expected, is the PowerPoint presentation; there is the soft toy thrown from participant to participant as a signal for whose turn it is to speak; there is the "share with us one thing you're passionate about"... So far, so familiar, so conventional. 

But, in the second half of the workshop, a surprise: a DVD about a lady called Jane Elliott. Jane, a schoolteacher, ran an exercise with the kids in her class to show how easy it is to discriminate, how quickly we adopt a position of superiority or inferiority and the effects of this discrimination on both parties.

What has this got to do with simulation?

The first thing that struck me was that all of the mannequins we use at the SCSC are "white", although other skin colours are available. In terms of reflecting the local population, the latest available figures for the NHS Forth Valley area are from the 2001 census, where 3180 (1.14%) of people recorded themselves as belonging to an ethnic group other than white. In Scotland as a whole (in 2001) 2% of people were minority ethnic. So perhaps this is not an issue? Perhaps simulation centres in parts of the UK with higher proportions of ethnic minorities reflect this within their mannequin population?

The next thing that struck me was Jane Elliott's discussion about power (in the DVD she compares the power (or perceived power) that an older, tall, white man has with the power that a young, smaller, black woman has.) One of my interests within simulation is power inequalities and I have almost totally focused on the power inequalities between professional grades (nurse vs. doctor, consultant vs. trainee, etc.). Jane broadened my horizons to include the way we might treat those who (for example) are of a different skin colour or nationality or those who have a visual or mobility impairment.

Simulation, as Gaba says, is a technique. It is not the solution to all problems, it cannot solve the problem of discrimination. However, active or passive discrimination by staff against patients (see for example the 2007 CEMACH report) or by staff against other staff, may result in patient harm.  We can (and should) therefore use the scenarios we run in our simulation centres to focus on all aspects of care which may reduce (or improve) patient safety including the ideas surrounding equality and diversity.

(Footnote: I would be interested to know if anybody out there uses E&D issues in any scenarios within their simulation centre.)