Walk in my shoes: Using VR to tackle racism and discrimination in the NHS
Researchers at King’s College London are investigating whether virtual reality can help to tackle inequalities and discrimination in the NHS.
Racism and discrimination happens in all sectors of society, including health and social care services. For people from racially or ethnically marginalised backgrounds, this means that the simple act of going to work can expose them to negative experiences that affect their careers, health and lives.
Since 2017, Stephani Hatch, Professor of Sociology and Epidemiology at King’s College London, has been Principal Investigator for the ground-breaking Tackling Inequalities and Discrimination Experiences in Health Services (TIDES) study.
TIDES is tackling discrimination against workers in the health sector by using virtual reality as part of a training package to help people understand what it’s really like to be on the receiving end of it.
As a first step, the researchers collected information about people’s personal experiences of workplace discrimination, bullying, and harassment, as well as when they have witnessed someone else being subjected to this kind of experience. They also gathered details of available reporting processes, training and support.
This research showed how pervasive and embedded discrimination is in the organisational structure and cultural norms, as well as providing evidence of the detrimental impact of everyday discrimination, racism and microaggressions on people’s health, mental health, work satisfaction and career progression.
The pandemic exacerbated these inequalities. It quickly became clear there was not only a disproportionate health impact of COVID-19 on racial and ethnic minority groups, including staff within the NHS, but also differences in how they were treated in the workplace. In response, Hatch and her team expanded TIDES to investigate this further.
“For some people, this is chronic exposure to discrimination enacted by colleagues and managers,” shares Hatch. “It’s become so infused within the culture, it’s become a question of how do we get colleagues, managers and leaders to understand what this really feels like?”
An innovative approach to Equality, Diversity and Inclusion training
People in management positions may have never experienced discrimination or microaggression towards themselves and may struggle to perceive or understand its impact on their teams. The challenge is to move the conversation on from “Is this really happening?” to “This is real — so what are we going to do about it?”
For many organisations, the solution has been to roll out Equality, Diversity and Inclusion (EDI) training. While a step in the right direction, EDI training is limited and often places the burden of solving workplace issues of racism, bullying and discrimination on those who are on the receiving end of these behaviours.
“We wanted to allow people’s stories to become a part of training and education in a way that took away the emotional and the physical labour of having to repeat examples of exposure to discrimination and racism,” explains Hatch. “Our aim is to try something different and innovative in this space to see the dial move.”
Their novel idea? Immersive training through virtual reality.
Hatch and her team had already used VR effectively in the past and now they are using it as a tool to deliver training and education in an engaging, empathic and experiential way.
Even when we know it’s not real, our bodies still respond to VR as if we are in a real environment and this includes triggering emotional responses. Being immersed in a scenario and physically experiencing it, is a faster way to learn compared to simply being presented relevant facts.
By enabling staff and managers to virtually ‘walk in the shoes of’ racial and ethnic minority staff most affected by racism, it enhances their ability to empathise and recognise those acts being experienced by their teams in everyday work.
Creating virtual experiences of discrimination
Experiences reported to the team during the study’s one-on-one interviews were used to develop a VR training resource that re-creates the experience of life, as viewed by someone from a different racial or ethnic background.
“It’s really important for us that we captured not only the experience of discrimination and racism, but also what it’s like to witness those experiences and how you might become an active, biased contributor to these scenarios by what you do in the moment and afterwards,” Hatch explains.
Working with storytellers and script writers, three VR films were developed in collaboration with Maudsley Learning and the King’s College London VR Lab. While wearing a headset, users ‘become’ staff members from ethnic minority groups as they go about their shifts. They follow scripted narratives on witnessing or experiencing workplace discrimination in an immersive 360-degree environment.
One film follows a woman who discovers she is being treated differently than her white colleague in relation to maternity leave, while another illustrates the impact of having unequal access to PPE.
The TIDES team collected feedback from collaborators, NHS peer researchers and a Stakeholder Opinion Group, at every stage of the scripting and design, ensuring they provided a realistic view of these experiences, allowing for a greater sense of realism and believability.
In the video below, Hatch describes how the VR scenarios were developed alongside her team members Dr Juliana Onwumere, Senior Lecturer in Psychology at King’s College London and Consultant Clinical Psychologist, and Dr Lucia Valmaggia, Head of King’s College London VR Lab.
Moving from conversation to change
In recent years there has been a growing momentum towards greater racial equity, driven in part by responses to the Black Lives Matter movement, with workplaces having more open conversations about structural racism and intersectionality.
“Yet despite implementing measures to tackle racialised inequities in the NHS, such as the NHS Workforce Race Equality Standard (WRES), there has been little progress,” says Hatch.
“There has been a lot of work to open up conversations. People are now listening but it’s not enough. We want to make sure that TIDES is properly integrated — not just as a tool of research, but something more practical and translational.”
The VR training films have been successfully piloted with Maudsley Learning and are now being trialled within a number of NHS hospitals. Alongside this, the study is building a network of VR champions.
These champions are members of staff who are not only trained to help colleagues get up to speed with the immersive technology but will also mentor and guide people on how to manage the difficult conversations that may emerge after going through the training.
The TIDES team is also developing a Race Equality Assessment toolkit that will be integrated with the immersive training scenarios, with the end goal of rolling out the toolkit across the NHS to complement and expand on existing EDI training.
“Tackling inequalities can’t stop once someone has a better understanding of what it’s like to be on the receiving end of discrimination or bullying,” Hatch says. “Efforts to tackle racism in health services need to demonstrate meaningful change.”
TIDES has the potential to make real change because its work is focused on the NHS -the biggest employer in Europe, with many people from racially marginalised groups working at different levels.
Over the next five years, as the toolkit develops and is rolled out, Hatch and her team want to see a positive shift in the WRES rather than the current levelling off.
“The VR training resources will help people to show up to work and check their behaviour, because we’re creating accountability for colleagues, managers and leaders to see, understand and do something about these behaviours happening around them,” Hatch concludes.
“You can’t have one difficult conversation and then you’re done. We want the VR training resource, and other tools the study develops, to keep taking things a step further to make change.”
The TIDES team have also led the creation of a report, commissioned by the NHS Confederation, that reviewed existing research on how anti-racist practices can be developed and what works in the context of healthcare workforce settings.
The findings have informed the development of the new NHS England resource: Combatting racial discrimination against minority ethnic nurses, midwives and nursing associates. The resource is designed to help nurses, midwives and nursing associates recognise and challenge racial discrimination. It also supports those in leadership roles to be inclusive leaders.
Want to know more?
If you’re a UK taxpayer, your contributions helped fund this work via the Economic and Social Research Council and UK Research and Innovation — the UK’s largest public funder of research. You can read more about what we do here. TIDES is also funded by Wellcome.
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