Dr Doyin Atewologun and Roger Kline are leading an independent research project for the GMC to help us understand why some doctors are referred to us by healthcare providers more, or less, than others. Here, Doyin tells us why she was keen to lead this work and what impact she hopes it will have on doctors and the systems they work in.
What is your interest and expertise in ensuring workplaces are fair?
By way of profession I’m an occupational psychologist, so I’m interested in the science of people at work. My expertise lies in getting the best out of people in the context of difference.
I work with organisations to evaluate and understand their processes – things like appraisals or how people are allocated to certain projects – to see how bias can come into play, and how that may advantage some and disadvantage others.
And I work with teams to help people think about how social demographic diversity and personality diversity can be harnessed, and how they can manage through conflict to reach a place where everyone feels like they can be themselves.
What made you want to get involved in this research project for the GMC?
We know that black and minority ethnic (BME) doctors are over-represented in the GMC’s fitness to practise processes, and that this is linked to the fact that they’re more likely than white doctors to be referred to the GMC by employers, but we don’t fully understand what drives this. There’s obviously something going on and, for me, that’s what’s interesting about this work.
I wanted to get involved for those individuals who feel almost trapped because they find themselves in a process that purports to be fair, which on the face of it is fair, and they can’t quite pinpoint how it’s not. This can be debilitating for an individual to experience.
I’m also interested in paying attention to the ways in which systems protect some people. Research shows us that if you’re from a minority group, you’re more likely to be scrutinised and held to higher degree of accountability – people are less willing to give you the benefit of the doubt, and more likely to formalise concerns.
And the inverse happens. If you’re part of the majority group, people are much more likely to give you informal feedback and let you know there’s a problem without escalating it. People are more likely to trust that you are inherently competent, so you are less likely to be thrown up by the system as someone who has gone wrong.
It’s about paying attention not only to how we treat outsiders, but also to the less visible ways we reinforce insider status.
Why do you think this research is important for doctors?
There is a swell of emotion from the BME medical community and, as a result, a greater recognition of the issues BME doctors face by the wider profession. At recent events I’ve attended, I’ve seen a lot of anger and frustration out there.
People working in healthcare feel stuck in a system where something is wrong. They feel marginalised and they think there’s very little they can do about it. It’s not right for anyone to be caught in those dynamics.
This research is about reassuring any minority group working in healthcare, not just BME doctors, that this problem is being owned by the healthcare system. The problem is not with ‘you’, the problem is with ‘us’. We’re turning our attention to what’s going wrong in the system, not just what’s happening to specific people.
How do you think this work will benefit healthcare providers?
For any organisation, whether it’s commercial or public sector, to perform at its best – whatever that is and however it’s measured – we have to work with all of the system. Everybody needs to be included, engaged, and used to the best of their ability and potential in order for everybody to benefit.
We know that where the wellbeing outcomes of people – no matter their position in the organisation – are improved the entire society benefits. As long as there is a group of doctors who are being treated in a way that feels exclusionary, it is not good for the rest of the NHS or the patients.
What do you hope the impact of the research will be?
One of our main aims for this research is to end up with good practice, which employers and managers can follow. We want to distil what we learn down to a set of recommendations, which we can point to and say this is what everyone should be doing and this is how everyone should be doing it. Overall, this will make for a more efficient use of resources.
What I’d really love at the end of this is for
- every responsible officer, HR director, line manager to take a moment to double check the assumptions they make when assessing someone’s competence and contribution. Generally speaking, we all have a prototype in our heads of what a good doctor or a good surgeon or a good leader looks like. And we tend to place more value (often subconsciously) on people who look like they fit these prototypes. So if I was making a decision about someone’s work, there are lots of ways in which that decision can be influenced by my preconceptions.
- anyone who is a position of authority or in a position of power just stops and asks themselves: What is the evidence for this? What is the counter evidence for this? If I was to imagine this interaction with a different kind of person, what would I do next?
I would just love for people to be always asking themselves these types of questions, and mitigating their own biases in an everyday way. That is what I hope the impact of this work will be.
Dr Doyin Atewologun and Roger Kline’s research is ongoing. You can find updates on the project on this blog and at www.gmc-uk.org/profession-under-pressure.