How to Recognize and Address White Fragility to Enhance Diversity Efforts in Health Care

Jul 29 / Dr. Sharon GE Washington



Leaders can unknowingly perpetuate white fragility in the workplace, which can lead to a lack of diversity and inclusion. White fragility is a term used to describe an individual’s defensive reaction to any challenge or critique of their racial identity.

It is rooted in racism, privilege, and power dynamics that are pervasive in our society. This article will explore how white fragility shows up in health care, what it looks like, and how it affects BIPOC (Black Indigenous and People of Color) employees.

White Privilege in Action

Embracing Racial Realities in Healthcare

White privilege refers to the societal advantages that white people have over non-white people simply due to their race. One significant aspect of white privilege is the ability to avoid or control the narrative around discussions of race. When white individuals center their own feelings, they are exercising this privilege by controlling the direction and emotional tone of the conversation. 

In discussions about race and racism, particularly within healthcare settings, it’s not uncommon for white individuals to center their own feelings and discomfort. This behavior can include crying, becoming defensive, or derailing the conversation by focusing on their personal emotional response rather than the impact of their behavior on BIPOC  colleagues and patients. This is a clear manifestation of white privilege.

This could also be seen as a physician or leader who refuses to acknowledge their own biases or blind spots when it comes to treating patients from different backgrounds. They may even become indignant at the suggestion that they might have something to learn about race and racism. 😡

Another manifestation of white fragility is an overreliance on colorblindness—the idea that ignoring someone’s racial identity is the same as being “non-racist” or “not seeing color.” This kind of thinking ignores the fact that race has a real impact on people’s lives, both good and bad. Refusing to acknowledge this fact denies BIPOC employees access to resources they need for success while simultaneously denying them recognition of their experiences. 🚫🌈

The Dynamics of Centering Personal Discomfort

How Avoiding Accountability Undermines Equity

When white individuals center their own feelings in conversations about race, several things typically happen:

 1. Derailing the Conversation: The focus shifts from the experiences and concerns of BIPOC individuals to the emotions of the white person. This often halts any meaningful progress in addressing the core issues of racism and inequity. 🛑🗣️
 2. Prioritizing Personal Discomfort: By making the conversation about their own discomfort, white individuals inadvertently signal that their feelings are more important than the lived experiences of BIPOC individuals. This reinforces existing power dynamics and silences those who are already marginalized. 😢❌
 3. Avoiding Accountability: Crying or becoming defensive can be a way to avoid taking responsibility for one’s actions or biases. It shifts the burden onto others to comfort or reassure the white individual, rather than allowing them to confront and learn from the critique. 🧺⚠️

The Impact on DEI

The Ripple Effects of White Fragility on Organizational Culture

When leaders are unwilling to address issues related to racism or privilege, it creates an environment where team members feels unsafe and unsupported. This leads to a decrease in engagement among BIPOC employees because they don’t feel like their contributions will be valued or respected. It also makes it difficult for organizations to achieve true diversity because the culture doesn’t support people from all backgrounds coming together and working towards common goals. 🤝

Furthermore, when white leaders try to shut down discussions about race with statements such as “Let’s just focus on our similarities instead,” they’re actually making it harder for BIPOC employees by refusing them agency over their own experience with racism—which leads us back around full circle into a cycle of white fragility and power dynamics that prevent meaningful dialogue from taking place within health care organizations. 🌀

Feeling unsupported and undervalued leads to disengagement. BIPOC employees and allies may become less motivated to participate in team activities, contribute ideas, or take on leadership roles. This disengagement is a direct result of institutional trauma, where the persistent failure to address systemic issues erodes trust and morale. 📉

When the organizational culture does not support inclusivity, it becomes challenging to attract and retain diverse talent. The lack of diversity stifles innovation and prevents the organization from benefiting from a wide range of perspectives and ideas. 🌐🛑

Institutional trauma

Institutional trauma occurs when the structure and culture of an organization perpetuate harm against marginalized groups. In healthcare settings, this trauma is often exacerbated by white fragility, creating environments where BIPOC staff feel consistently undervalued and alienated.

When issues of racism and privilege are not addressed, it creates a pervasive sense of insecurity among BIPOC employees. They may feel constantly on edge, anticipating further instances of discrimination or microaggressions. This environment is not only detrimental to their mental health but also impacts their ability to perform effectively. 🛡️💔

Impact on patient care

White fragility in health care can directly affect patient care. When physicians and healthcare providers are unwilling to confront their biases, it can lead to disparities in the treatment and care of patients from diverse backgrounds. For example, studies have shown that Black patients are less likely to receive pain medication compared to their white counterparts due to biases in pain perception. 🩺💊

Moreover, a healthcare provider who is defensive about their biases may dismiss or overlook the cultural needs of patients. For instance, a patient from a particular cultural background might have specific dietary restrictions or preferences that need to be considered in their care plan. Ignoring these needs can lead to poorer health outcomes and decreased patient satisfaction. 🍽️❌

Impact on teaching residents

Fragility can show up among faculty when increasingly diverse cohorts of learners increase representation, but as these learners name concerning and problematic behaviors and patterns that white faculty often didn’t recognize, it can lead to an inversion of the teacher/learner power dynamic. This inversion can activate white fragility, leading to BIPOC residents and those with marginalized experiences being labeled as challenging, confrontational, non-collegial, hyper-critical, and other misrepresentations. These labels become additional challenges for residents to navigate during their training. 📉⚠️
When BIPOC individuals name whiteness and privilege as factors hindering their inclusion, white individuals may respond with defensiveness or denial. This reaction often stems from discomfort and a lack of understanding of how systemic racism operates. Instead of acknowledging the valid experiences of BIPOC colleagues, white individuals may try to reframe the conversation to avoid confronting these issues. 😡🛑

When BIPOC residents or staff point out that their evaluations are influenced by racial biases, white evaluators may react by defending their fairness and objectivity. This defensiveness is a manifestation of white fragility and prevents constructive discussions about implicit bias and how it can be addressed. Instead of learning from the feedback, the focus shifts to protecting the self-image of the evaluator. 🚫📝

The ongoing use of race-based medicine, such as assumptions about biological differences based on race, is another area where white fragility can be triggered. When BIPOC individuals challenge these outdated and harmful practices, white colleagues may feel attacked and respond by dismissing or minimizing the concerns, rather than engaging in meaningful dialogue about the need for evidence-based and equitable medical practices. 🩺🔬

Intent vs. Impact

A crucial concept to understand in interrupting this form of fragility is intent vs. impact.

  • Intent refers to what a person means to do or say.
  • Impact refers to how those words or actions are received and the effects they have on others.

In conversations about race, well-meaning white individuals may not intend to cause harm, but their actions can still have a negative impact. For example, a white healthcare leader might cry during a discussion about racial bias, intending to show empathy and sorrow. However, the impact of their tears might be to shift the focus away from systemic issues and onto their personal feelings, thereby minimizing the voices and experiences of BIPOC colleagues.

Fragility in Other Dominant Identities

White fragility is not the only form of fragility that can hinder DEIA efforts in healthcare settings. Individuals with other dominant identities can also display fragility, impacting the progress towards an inclusive and equitable environment.

For example: 
  • Resistance to using correct pronouns and acknowledging gender identities can be a form of fragility among individuals who hold cisgender privilege. This resistance often stems from discomfort with changing social norms and a lack of understanding about the importance of affirming someone’s gender identity. This behavior can create a hostile environment for transgender and non-binary individuals, reducing their willingness to seek care and their overall wellbeing. 🌈🏥
  • When initiatives are introduced to support LGBTQ+ staff and patients, such as inclusive language training or gender-neutral bathrooms, some individuals may express discomfort or opposition, claiming that these measures are unnecessary or disruptive.  This opposition can create an unwelcoming environment for LGBTQ+ individuals, reducing their sense of safety and belonging and undermining efforts to promote inclusivity. 🌈🚻
  • Individuals with male privilege may feel attacked when issues of gender inequality are raised and may respond defensively. This fragility prevents meaningful conversations about sexism and the development of strategies to promote gender equity. 🚺🚹
  • When younger employees or patients raise concerns about ageism or suggest new, innovative approaches, older colleagues may react defensively, dismissing these ideas as naive or unnecessary. This defensiveness can stifle innovation and perpetuate age-based biases, creating an environment where younger individuals feel undervalued and older individuals feel threatened by change. 👶👵

How to address & interrupt white fragility

1. Acknowledge the Privilege: Recognize that centering personal feelings is a form of white privilege and that it can derail important conversations about race. Acknowledging this is the first step towards change. 🙇‍♀️💡
 2. Focus on Impact: Shift the focus from intent to impact. Understand that regardless of the intent, the impact of centering personal discomfort can be harmful and counterproductive. Encourage an environment where the impact of actions is discussed openly and respectfully. 🔄💬
 3. Create Safe Spaces: Establish and maintain safe spaces where BIPOC individuals can share their experiences without the conversation being derailed. This includes setting ground rules for discussions about race, where centering personal discomfort is discouraged. 🛋️🗝️
 4. Encourage Active Listening: Promote active listening, where the primary goal is to understand and validate the experiences of BIPOC colleagues and patients, rather than to defend oneself or seek comfort. This helps in maintaining the focus on the core issues. 👂❤️
 5. Educate and Train: Provide ongoing education and training on DEIA (Diversity, Equity, Inclusion, and Antiracism) principles, including the concepts of white privilege and fragility. Ensure that all staff understand the importance of focusing on the impact of their actions. 📚🌟
 6. Foster Accountability: Develop systems for accountability where individuals are encouraged to reflect on their behavior and its impact. This can include regular feedback sessions, peer reviews, and facilitated discussions on DEIA topics. 📝⚖️

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White fragility can have far-reaching effects on any organization looking to create an inclusive environment where everyone feels supported and valued. It undermines progress towards diversity by creating silences around conversations about race, privilege, and power dynamics—all topics which are essential for creating equitable workplaces where everyone has access to opportunity regardless of their background or identity. By being aware of these issues, leaders can help foster an environment where everyone feels respected and empowered—and ultimately make real progress toward creating lasting change within health care systems worldwide. 🌍🏥💖

By addressing white fragility and implementing strategies to promote DEIA, healthcare organizations can improve patient care, support their employees, and create a more inclusive and equitable environment for all.
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