Shared non-news item: A prominent and very large healthcare system that recently paid out a large sum of money for gender discrimination and a hostile work environment has produced new policies and procedures regarding such behavior. Step in the right direction? The old policies were pulled out and when compared to the new ones, little had been changed. Surprised? I’m not.
Most policies sound great on paper. Their intent may be flawless. The behaviors they proscribe and prescribe are idealized versions of the way we hope people will behave if we strip away the centuries of evolved norms and expectations (not to mention the ingrained culture of the institution). Elimination of gender roles, gender stereotyping and gender politics must occur before these policies and procedures have any meaning, much less any effect.
After a certain point regulations, procedures and policies are not only not helpful, but they actually become barriers to change. They are harmful. First, said document presumes that it has neatly defined the “problem.” Mistake #1–behavioral mores vary from place to place and in different contexts. Emergencies that require help in an otherwise quiet place, shouting at someone to get that help is appropriate. In contrast, when something much less serious occurs and shouting is the method of communication, some would find that behavior inappropriate or even disruptive to an environment that requires high degrees of attention to task.
Second, the existence of the policy/procedure gives the sense that the problem has been addressed. Mistake #2–even in the most detailed documents there is room for abuse and misuse. Either the policy or procedure is not uniformly or fairly enforced, or, as we have seen with “disruptive physician policies” they are used as a tool to punish enemies of those in power. The most elaborate, detailed policies are the ones that enjoy the most room for abuse.
My answer? As for small children, we have not only to teach and but also to reward behavior that will achieve the desired effects. Let me explain.
I work in two different operating rooms. One is at the Children’s Hospital, the other is at the Sister’s of Charity (a Catholic Hospital) ambulatory surgery center. The skills of the nurses and other staff are outstanding at both. I could not ask for better support teams. And I have treasured lifelong friends among the staff at the Children’s and am beginning to make some at Sisters as well. So why do I find it so much more difficult to work at Children’s, even after all these years.
The cultures differ in at least one very important way. At Sisters there is what I would call a culture of helping. No one ever says that it is not my job. Unencumbered by union rules, everyone is constantly looking for ways to make every task easier for his/her co-worker, and especially for me to make my patient’s experience safe and effective and memorable. When something doesn’t go right, everyone takes part in thinking “how could I have helped to make that situation better.” Yes, I recognize that a small ambulatory surgery center is not as complex a society as a Children’s Hospital, but the point is that culture matters.
So back to solving the problems of gender equity. If an institution wants to change its culture, its leaders (the so-called parents) have to directly, pointedly and publicly display and reward behavior that achieves that goal. Interactive programs for learning new skills and adjusting attitudes where outcomes are measured and concrete rewards follow are more effective in the culture of an institution or organization.
If anyone reading this has developed or been part of such programs targeted towards achieving gender equity, please share!