Fighting for Racial Justice in Your Emergency Department

Structural racism is a public health emergency that squarely intersects with the overdose crisis and emergency medicine.

To pursue our mission of improving the treatment of substance use disorders in acute care hospitals, we must enhance care for people with marginalized identities. Kara Toles, M.D., Assistant Clinical Professor of Emergency Medicine at the University of California-Davis, is addressing structural racism in her emergency department as the department’s first Director of Equity and Inclusion (DEI). Kara shares her experience to empower anyone seeking to be a catalyst for DEI efforts at their hospital.

Getting Started

Evaluating the buy-in of her hospital. One of Kara’s first steps was confirming that department leadership was truly invested in DEI. After conversations with trusted faculty members, she concluded that, overall, there was a good level of receptivity to this work both in the department and within the University as a whole. 

Knowing her worth. This effort, like any other hard work critical to an institution’s success, should be fairly recognized, compensated, and supported. Too often, women and people of color are tokenized into leading DEI efforts and expected to do it on a volunteer basis, fueled by passion alone. Knowing this, Kara negotiated for a title, appropriate compensation, a budget, and a staff member to assist with administrative duties. 

Developing a common foundation through collective training. Kara accomplished this by teaming up with the UC Davis Health Office for Health Equity, Diversity and Inclusion to develop a curriculum based on their Supporting Educational Excellence in Diversity (SEED) training and modified it to fit the needs of the emergency department. 

Assembling a team and creating a sustainable structure. Kara’s ask was simple: an open call via email to all faculty, residents, and fellows for volunteers to join a DEI committee. A key aspect was recruiting a diverse group of individuals. With widespread interest in joining this initiative, Kara set up a structure in which the larger DEI committee was made up of smaller subcommittees, each with a designated leader.

Tips to Strengthen Your DEI Initiative

With a few key pieces in place, you too can begin your journey toward equity in emergency medicine. 

• Identify the building blocks that are already in place in your institution. This could be an office dedicated to health equity, a values statement, or other public statements.
• Find your allies including those with lived experience with discrimination and non-minoritized people, particularly those who have access to channels of power and privilege.
• Get a lay of the landscape by learning if DEI work has been conducted and asking how it went. Understanding previous challenges can help you set a plan to overcome those barriers.
• Get institutional backing to ensure you have the support required to make the pursuit of this work worthwhile. Make sure that your leadership is truly dedicated to DEI work, specifically when it comes to the active redistribution of institutional power.
• Take care of yourself as this work can be physically and emotionally draining, particularly if you hold minoritized identities. Ask for help if you need it. Take a break when you need to.

“Active allyship from colleagues who held privileged identities was crucial in pushing this work forward.” – Kara Toles, M.D.

Together We Can Reimagine a Better Future

In a country where Black, Indigenous, and people of color face worsened health outcomes, particularly when involving substance use, emergency departments are called upon to work toward an equitable, just society.  Groups of passionate individuals can re-orient department goals to include tenets of DEI, create departmental policies and practices that incorporate racial equity, engage with the local community around racial justice, and carry out clinical research and education to document and understand racial disparities. Together, we can reimagine a future where racial justice is realized, and health systems ensure fair treatment for people of all races, resulting in equitable access and outcomes.

For the full story, check out First Steps for Advancing Diversity, Equity, and Inclusion in Your Emergency Department.