Equality, diversity and inclusion (EDI) is a very pertinent and timely topic today especially over the last 16 months or so with the emergence of the COVID-19 pandemic which has also brought a number of EDI related issues to light. Be it in light of the disproportionate impact of COVID on Black, Asian and other Ethnic Minority communities and other marginal groups in society not only here in the United Kingdom, but more globally or just the overall challenge of talking about health inequalities! Needless to say, Occupational Health is not just about providing adjustments for employees with disabilities as I will hopefully demonstrate in this reflective piece, but more as an agent of change through an EDI framework of allyship.
Let us start with the basics – Equality is about everyone having an equal chance regardless, Diversity is about one’s “uniqueness” and Inclusion is the “act” of creating fairness. On reflecting on what this has to do with Occupational Health and whether or not we as practitioners have a role in promoting or embedding EDI, it did not take me long to see the relevance and see where allyship would fit in. Allyship is not just a fancy concept – it is evidence based (music to any clinicians ears) and historically a concept that has used more within the employee welfare, wellbeing and working with affinity groups also known as ERGS (employee resource groups) e.g. gender, race, mental health to mention a few; but if you do not remember anything about this concept, remember these the three things about allyship as explained by Sheree Atchen, a global EDI leader who described allyship as actively promoting EDI by being intentional, positive and making a conscious effort in order for you to make that difference in changing culture at work.
Jennifer Brown a world renowned expert on allyship stated that “allyship is a journey” and not a destination and more importantly, there are no fixed or perfect answers … she created an ally continuum as a way to help acknowledge the personal journey of allyship as shown in Fig 1.
The Ally Continuum Source: From Unaware to Accomplice by Jennifer Brown
When I first started in Occupational Medicine, there was the perception that I was expected to only provide advice, recommendations, guidance …. and not getting necessarily involved (or seem to get involved) in any management related issues or employee-employer “disputes” and I was taught and trained to “remain as impartial” as much as I could whilst doing so! … and when things did not necessarily go the way I expected , I found myself trying as much as possible to avoid getting a formal a complaint that would ruin my ARCP (Annual Review of Competency Progression) as a trainee or annual appraisal when I ultimately became a Consultant!
As funny as that might seem …. I think for many of us as practitioners that would seem to be the case for not wanting to get involved with EDI – but really, is that what we are about?
I think the Allyship spectrum that ranges from being apathetic to becoming an advocate does reflect a lot of what we do as Occupational Practitioners but in essence, we have a choice …. we could commence and remain at the apathetic end of the allyship spectrum as part of our personal allyship journey with little or no awareness of the organisational EDI issues and position ourselves as far away as possible from the essence of EDI and be perceived as a medical service that believes in silo-working with poor strategic engagement and minimal impact and therefore be perceived and obtain a reputation as being a service of poor value for money spent. On the other hand, as professionals we can actively engage and promote awareness, take on more active and advocacy roles to make that difference for the better when it comes to advancing the inclusive culture at work as both Jennifer and Sherre both alluded to in their articles.
So what do I mean by being an ally for EDI in our occupational health roles?
I will hopefully illustrate this by using three personal stories from my clinical practice (names and personal details changed for confidentiality purposes):
Peter was a 32 year old Logistics Manager who was referred just before going through a disciplinary. He has been off work with stress for 10 months and had been previously referred to occupational health twice in the last 2 years. I had asked for further clarification following receipt of his referral on this particular occasion. He was described as a “poor team player” who did not “engage” with others and did not make “eye-contact” when spoken to by his manager. Although he had a prior history of anxiety having fled a war-torn country, that was not the reason for his referral. During his consultation, I identified a number of EDI ”related” factors: African culture of not looking at older people / leadership in the face, not going to pub after work for religious reasons which was the “customary” way of socialising and “team building” in his particular team. As a result, I ended up delivering a number of culture awareness training / stress awareness session for both management and their human resources teams.
My second case was John who was a 38 year old Project Manager and was also referred for work stress. He kept falling asleep in meetings and after being embarrassed in a meeting in front of his colleagues by his line manager, he then went off with stress. His consultation revealed that he was a new dad of 10 week old twins, juggling a “disproportionate” work –life balance. He was not aware of the organisation’s work life HR policy and the advice was for the policy to be shared and explained to him via HR and he was able return to a flexible work pattern which allowed for him to work as well as support his wife with the babies … and get the well earned rest he needed.
Sally was a 53 year old Office Manager and was referred as she was “forgetting things”. She had been reprimanded by her line manager for forgetting to lock the safe after misplacing her keys! She then went off work with stress and was thinking of retiring after 28 years’ service. At her consultation, she admitted struggling with being perimenopausal and managing her symptoms and concentration at work. She cited that she worked within the context of a predominantly male team / environment and as such, did not feel able to inform her manager about her experience. Following her assessment, I was able to provide the FOM guidance on managing menopause at work to her manager (with her consent), refer her for some supportive intervention through the company EAP (Employee Assistance Programme) and more importantly, introduce menopause guidance and a checklist as part of a HR policy review.
These cases illustrate the EDI factors that we commonly come across in our clinical practice. Stress in the workplace is common and takes up about 75% of my clinical case load and it is clear that accessing an occupational health service did make a difference for each one of the cases of “stress at work” – Peter needed to be understood within the context of culture and his religion, John within the context of his work-life balance and Sally within the context of her age and accompanying physiological changes – all presented to Occupational Health as stress at work cases but all were clearly managed differently based on these simple leadership principles of awareness, involvement, engagement and being outcome focussed.
Well you might ask the question – what if I am not in a leadership role? I would simply respond by stating that I managed all three as a cases “trainee” which is not exactly at “leadership” level and I was able to still make a difference by raising awareness, engaging and educating. As I have subsequently evolved into a more strategic role, I find myself now more involved with strategy and policy development, working with employee resource groups (ERGs), law and not just Human Resources departments – the lesson being that – leadership has a role at all levels when it comes to Occupational Health – be it as a technician, nurse, physiotherapist, physician and not just at directorship & Chief Medical Officers levels!
In summary, I think as Occupational Health professionals, we are uniquely placed to make a difference when it comes to promoting EDI at work and allyship has been shown to work be it by simply promoting awareness, improving engagement or just by being curious! After all, as Maya Angelou stated … when we know better, we do better!
So what are my 3 key messages?
Allyship a journey and there are no fixed or perfect answers when it comes to promoting and embedding change through EDI. Second, even the same situation can end up being addressed differently as demonstrated in my personal stories of managing stress at work within my occupational health clinic. Finally, as an occupational health provider, I would challenge you to be curious, be unique, be fair and play your part in creating inclusion and fairness at work as you might just make a difference ….. for the better!
Dr Sade Adenekan MBChB MPH MSc MFOM
Dr Sade Adenekan is a Consultant Occupational Physician & Accredited Specialist in Public Health in the United Kingdom who previously worked in the NHS for over 20 years in Primary Care, Public Health and Health Services Management before retraining in Occupational Medicine. She currently works for a Corporate Global Oil & Gas Company and is passionate about Mental Health and Equality, Diversity & Inclusion within the Workplace.