What Duke Healthcare Must Learn from Disneyland

Polis: Center for Politics
4 min readMay 13, 2024

Anna de Pourtales (PPS ‘24)

Anna de Pourtales (PPS ‘24)

Disney creates magic that leaves a lasting memory in children and adults. The moment you step foot into its theme-parks, you are transported into a world of wonder, every detail carefully crafted for a joyful experience. Nicknamed “the happiest place on earth”, Disneyland intentionally incorporates multi-lingual signage and accommodations for developmental and physical disabilities. This sends the message: “You are welcome here”. This focus on every guest’s experience can teach healthcare decision-makers about catering to the patients they serve.

Lack of inclusivity in healthcare spaces means many feel excluded and powerless over their health. Healthcare decision-makers’ design choices directly influence patient outcomes and satisfaction. As an international student, I was shocked by the extraordinary cost and burdensome insurance paperwork of the US healthcare system. However, it wasn’t until tutoring refugees in Durham, NC, that I realized what it is like navigating US healthcare when English is not your first language. Working as a student researcher on barriers to mental health care for Latinx families in North Carolina strengthened my belief that the healthcare space must become more inclusive.

An example of how healthcare design falls short is Duke University Hospital’s new $265 million tower. It has no signs in Spanish on four pediatric floors despite Hispanic children occupying approximately 25% of the beds.[1] The issue of accessibility for “minority” patients, who comprise a significant part of the demographics Duke serves, was overlooked.

My research mentor, a Duke pediatrician, recounts the story of her patient, a suicidal 11-year-old Hispanic girl whose mum had finally agreed to bring her to the ER. While in crisis, the girl had to translate signs so her mum could navigate them from the car park to emergency psychiatric care. These moments emphasize to community members that “this space was not designed with you in mind”, reinforcing negative perceptions that healthcare is impenetrable.

Comparing this with Disney, decision-makers are acutely aware of their guests’ experience and aim to make all non-essential components of that experience seamless.

Disney’s commitment to accessibility aims “to reflect the rich, diverse world that we live in”. The 2022 Disability Equality Index gave Disney a perfect score of 100%. Disney’s parks aim to empower those with differences, be it language, physical or mental capacities. Disney brings sign language into their shows, has services to enable visually challenged visitors to enjoy an entertaining storytelling method, employs multilingual staff, and represents people from various racial and ethnic backgrounds in park characters. “What might seem like such a small detail to some can change how an individual feels about their whole world”.

Critics of my analogy would say “A healthcare facility is not Disneyland” and that “we are setting ourselves up for dissatisfaction”, as people are presumably sick and dissatisfied when interacting with hospitals. However, Disney can teach healthcare the core value of diversity and inclusion to reach its full potential. This change starts at a leadership level, which is why a diverse leadership team that can advocate for underrepresented groups is essential.

Vaccination programs during COVID-19 serve as success stories for reducing and removing systemic entry barriers. For example, when LATIN-19 (a NC advocacy group) collaborated with Duke Health to undertake COVID-19 vaccination campaigns, the number of people reached identifying as Hispanic/Latinx increased significantly. One way Latin-19 ensured this was by emphasizing the importance of not asking for ID, to make people feel welcome by alleviating concerns about immigration status. This required state policy change to ensure coverage to hospitals that didn’t ask for ID. A bilingual sign at a Duke event stating “No ID Required” visually assures families of their safety and welcomes them, reducing concerns about immigration. Community health workers recount Hispanic patients driving from Cary to Duke Latin-19 events because they didn’t “want to deal with the nonsense anywhere else”.

Diverse administration is crucial to ensure communities have advocates and are included in designed spaces and policies. The Latin-19 example shows that administration should collaborate with existing community organizations, which can provide input on people’s experiences navigating healthcare. When policy change occurs, administrators must remain vigilant and ensure practice follows policy. Additionally, diversity in medical school is essential to ensure underserved populations have physicians who represent them. The Healthcare Information and Management Systems Society states that inequity is healthcare‘s biggest challenge. They have drafted a guide for healthcare facilities to improve practice.

My favorites are listed below:

· Ensure inclusivity in physical space

· Use inclusive signage

· Ensure appropriate communication methods

· Expand the scope of inclusive healthcare delivery

· Self-educate on diversity in all its forms

[1] Paniyotti , G.M. (2022) “Bass Connections Lecture and interview on Latin19 during Covid,” 11 November.

Anna de Pourtales is from Oxford, United Kingdom and an Undergraduate at Duke University’s Sanford School of Public Policy. This piece was submitted as an op-ed in the Spring ‘23 PUBPOL 301 course. This content does not represent the official or unofficial views of the Sanford School, Polis, Duke University, or any entity or individual other than the author.

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