Cultural Competence in the Industrial Setting

By: Susan Taah, ATC, LAT, CEIS

For Black History Month we will talk about a topic that is near and dear to my heart, equality in the workplace.

It should come as no surprise that the demographics of workers compared to supervision are often skewed similarly to athletes and their coaches. Racism has been baked into American industry as jobs followed the white flight from the cities. Moving industries from urban centers out to rural and suburban areas made it harder for African Americans to access, as they were much less likely to be licensed or have the capital to purchase an automobile. Even today, instances of discrimination remain prevalent as seen in the 2012 racial discrimination suit against Coca-Cola where African American & Latino employees accused the organization of inequities in promotional advancements, punitive & retaliatory actions against minorities, & disproportionate dispersion of overtime hours. This lawsuit came barely a decade after Coca-Cola settled for $200 million dollars for discriminating against black workers in 2000. 

While the majority of cultural competence for athletic trainers is centered around disparities in medical treatment, industrial ATs may find themselves at the heart of one of the greatest disparities in our society–workplace discrimination. The Equal Employment Opportunity Commission of the United States is clear: Employees have a right to work free of discrimination. 

Industrial ATs who are embedded in their sites may find that this is not always the case. Though we are often outsiders looking in, here is my advice for any AT wondering how they can help workers everywhere work free of discrimination.

Don’t be color blind: Forbes published this article on how color blindness in the workplace backfires. The study showed that Black individuals perceived the most racial bias from participants who didn’t mention race. Color blindness is a form of microinvalidation. Not only will you miss discrimination by behaving in this way, but you will also likely compound it.

Embrace multiculturalism: Learn and take interest in the cultures represented by your working population. Take note of special holidays that will apply to them and be open to acknowledging them, respectfully. Learn about what work means to them in their culture, how their heritage influences their approach to illness or injury. Workers who distrust conventional medicine will likely lump you in with that. It is your responsibility to gain their trust and meet them where they’re at. You won’t win by attempting to invalidate or dismiss them or their beliefs.

PRO TIP: The more cultures you embrace at work, the more free food you eat.

Don’t ignore microaggressions: This goes hand-in-hand with being color blind. Microaggressions are more likely to occur than blatant acts of racism or sexism. They are difficult to identify because of their covert nature, but that doesn’t mean they are less harmful. Constantly joking about a Mexican member of the team getting the most work done can be a microaggression. Asking a Black worker why they wear a hair covering or asking to touch their locs can be a microaggression. Never be the aggressor, and when you see it happen take time to discuss with the employee when it’s convenient. If possible be an ally and talk to the person responsible. It may take a few months of being consistent, but you will notice that behavior cease when you’re around.

Be an agent of equality: Addressing equality in the workplace is a system level initiative. Unfortunately, this is often not a change that industrial ATs can make at a jobsite. But, that doesn’t mean you can’t directly impact the fair treatment of employees in your care. Maybe you notice that a particular supervisor blames one demographic of employees for faking injury more than another. Maybe the light duty work given to some employees is more glamorous than that given to others. You may even see inequities in medical treatment. As your team’s AT, you need to shield their path to recovery from discrimination and inequality. In the past I have had to request supervisors refrain from making certain comments to LGBTQ+ employees, reported them to HR or their hire-ups, or put eyes on injured employees in their departments to shield them from inequality. I have helped minority patients communicate with their doctors in a way that they would be taken seriously, found discrepancies and issues with notes or treatment, and followed up with the doctor to answer questions they had relating to their condition.

Provide a safe space: Do employees feel comfortable being open and honest with you? Can they tell you if they feel that they are being mistreated by their supervisor without fear of exposure? Can they tell you that they haven’t been taking their medication because they don’t trust it without the fear of being labeled non-compliant? Do they believe that you are putting their health and safety first? Can they TRUST you? If not, you have work to do. I have a piece on gaining trust and communicating with industrial employees that might be worth the read. (Click here to read Connecting With Your Patient Population in the Industrial Setting)

Do not pretend: This is the most important advice I can give. So, I will elaborate a bit here because I couldn’t complete this post without including this message to anyone who may harbor discriminatory opinions and beliefs. If for any reason, you believe people are unequal whether it be due to race, gender, sexual orientation, religion, or any other reason, you have two options: grow up, or get out. Believe it or not, it is impossible to separate yourself from your biases during the workday. If you do not put in the growth of becoming a culturally competent clinician and being knowledgeable about the issues that accompany prejudice, you will never be capable of giving high quality care to your patient population. There are too many resources out there to use ignorance as an excuse. Take Harvard’s implicit bias surveys to scope where you might have gaps, then do the hard work of closing them. Click here to take the Implicit Bias test.

Do not pretend for your comfort that your biases don’t hurt anyone. They do. 

Do not pretend that you are treating all patients fairly, you’re not. Do not pretend that you are not contributing to a system of inequality and discrimination, you are. 

When I worked at a tire manufacturer, we had an employee who was always emblazoned in Trump gear sprain his AC joint. As the only Black female in our AT clinic with white female and male coworkers, it was interesting but not surprising for me to learn that he preferred working with me over my peers even though he knew we were in political disagreement. When I worked with him, I mentally acknowledged the biases I possibly harbored and chose to grow up. I made an effort to combat my prejudice and instead created an environment of integrity and fair-dealing that put his health first and foremost and allowed us to have a genuine working relationship. 

Do not pretend. Choose to be anti-racist. Choose to be anti-homophobic. Choose to be anti-sexist. Choose to be anti-discriminatory. A bias being covert does not render it inert. If the idea of making such an effort is of no interest to you, caring for people may not be where you are best suited.

Workplace inequality has affected generations of health, wealth, and happiness for many Americans and even to this day is often an elephant in the room. If you made it this far, I want to leave you with the reality of this situation in hopes that you will truly dedicate yourself to being a culturally competent industrial AT. Here are a couple discrimination cases that have been settled over the last two years:

• Porous Materials (Ithaca, NY) $93,000: “The extreme bullying and harassment allegedly included a manager using racial slurs toward his employees, calling foreign workers “terrorists,” telling immigrants to leave America, and making unwanted sexual advances toward female employees.”
  
  
• Prewett Enterprises, Inc $250,000: “Prewett and Desoto supervisors and managers subjected African American employees to daily harassment and humiliation because of their race by calling them racially offensive and derogatory names and assigned Black employees the more dangerous job duties.”
  
  
• Jacksonville Plumbers & Pipefitters Joint Apprenticeship and Training Trust $207,000: “for applicants who allegedly were denied apprentice­ship positions because they were Black.”

What would you do if you witnessed any of these events? The reality is not one of us is capable of ending racism, sexism, ageism, or any other form of discrimination. But, we can deliver informed care that accounts for the existence of these structures. Do older employees seem to be pushed to return from injury faster than they should be? Are Black employees doing more dangerous or physically demanding tasks? Maybe Puerto Rican employees seek a healer instead of reporting their injuries, or female employees don’t have equitable access to bathrooms or feminine products. 

These are areas where you as a clinician can be indifferent or make a difference in the lives of your patient population. I hope you will join me in choosing the latter and being the most culturally competent clinicians we can be.

Sources: 

https://www.washingtonpost.com/archive/politics/2000/11/17/coke-to-pay-193-million-in-bias-suit/6a43c0c7-dcde-4d8c-a95f-3fe57c508c85/

https://www.vanguard.edu/uploaded/Academics/Graduate/Organizational_Psychology/Modern-Day-racism-in-the-workplace-Symbolic-diversity-or-real-change.pdf 

https://hbswk.hbs.edu/item/6919.html 

https://www.eeoc.gov/initiatives/e-race/significant-eeoc-racecolor-casescovering-private-and-federal-sectors 

https://www.forbes.com/sites/hbsworkingknowledge/2013/01/20/the-case-against-racial-colorblindness-in-the-workplace/?sh=350084f36a6f