Preventing Microaggressions From Souring Your Organizational Culture

Laura M. Cascella, MA, CPHRM

Workplace culture is a complex weaving of values, beliefs, behaviors, standards, goals, priorities, perceptions, and more. In healthcare, the importance of organizational culture is heightened because of the serious nature of the work and the esteemed role of medicine in society. A toxic culture can have widespread consequences, including staff burnout, turnover, and absenteeism; suboptimal care and patient harm; loss of reputation; and liability exposure.

Although addressing overt cultural issues — such as disruptive behavior and harassment — is essential to establishing a positive culture, organizations also must be aware of subtle issues that can erode efforts to support a diverse, equitable, and inclusive workplace. These actions often come in the form of microaggressions.

What Are Microaggressions?

Microaggressions refer to common and subtle behaviors that are biased or discriminatory toward a marginalized population, such as women, people who are racial minorities, individuals who identify as LGBTQ+, and people who have disabilities. Microaggressions typically fall into three categories: verbal, behavioral, or environmental.

• Verbal microaggressions occur when someone says something hostile, derogatory, disrespectful, or offensive about a marginalized group (to someone in that group or to others); for example, telling racist jokes or calling a colleague by the wrong name because their name is “too difficult” to pronounce.
• Behavioral microaggressions refer to behaviors or actions that are discriminatory, insensitive, or exclusionary; for example, excluding a person who identifies as LGBTQ+ from an event that is focused on couples or families.
• Environmental microaggressions are broader issues associated with lack of representation and diversity in various facets of society; for example, having an organizational leadership team that is not representative of the diversity of the workforce.¹

What Impact Do Microaggressions Have?

Although many instances of microaggression may seem harmless or unintended rather than pernicious, their impact can be significant. Simply chalking up the targeted person’s reaction (or someone else’s reaction) to these behaviors as hypersensitive or disproportionate only reinforces the negative behavior and further deteriorates organizational culture.

An article in Harvard Business Review notes that “research is clear about the impact seemingly innocuous statements can have on one’s physical and mental health, especially over the course of an entire career: increased rates of depression, prolonged stress and trauma, physical concerns like headaches, high blood pressure, and difficulties with sleep.”²

In healthcare, microaggressions also can worsen problems that already plague the industry, such as burnout, lack of job satisfaction, and staff shortages. These behaviors also might lead to patient dissatisfaction and harm (e.g., in relation to biased decision-making or disengaged staff). Ultimately, if not addressed, microaggressions might reinforce health disparities and inequities.³

Why Are Microaggressions Difficult to Address?

Microaggressions stem from bias, and — although bias is a recognized issue in healthcare — addressing it is problematic because it often is implicit. Microaggressions are particularly tricky to tackle because they are both brief and common, and they sometimes can even masquerade as a compliment or endearment (e.g., “You’re very good with technology for an older woman!”). These issues might make microaggressions difficult to identify.

Further, even when these behaviors are detected, they might be difficult to confront because of (a) their imprecise nature, (b) the discomfort associated with tackling complicated, emotionally charged topics, and/or (c) lack of awareness or denial that a problem exists. Yet, failure to identify, name, and challenge microaggressions can sour the workplace culture and psychologically harm and alienate an organization’s most valuable asset — its staff.

How Can Healthcare Organizations Confront Microaggressions?

In recent years, an increased focus on diversity, equity, and inclusion (DEI) in many industries has resulted in more research and information about tackling barriers to achieving DEI, such as microaggressions. Although strategies and best practices will undoubtedly evolve, healthcare organizations should be proactive in safeguarding their organizational culture against microaggressions and other types of bias. Below are some recommendations for consideration:

• Evaluate your organization’s commitment to supporting DEI and establishing a culture of dignity and respect. Engage organizational leadership in determining where improvements have been made and where opportunities still exist.
• From an organizational standpoint, acknowledge that microaggressions exist, and start the conversation with employees about these issues. Do not avoid difficult discussions in the hopes that problems will resolve on their own. “Not addressing microaggressions leads to a hostile work environment for victims of the interactions, who are usually already marginalized . . . This can escalate to a fractured workplace culture or the loss of employees who don’t feel valued at work.”⁴
• Take a nonpunitive approach to discussing microaggressions, and make sure all employees have the chance to participate. Singling out certain groups can lead to further division or an “us vs. them” mentality.
• Establish ground rules for respectful dialogue, positive attitudes, and solutions-focused discourse. Make sure everyone is held to the same standards.
• As part of diversity training, educate employees about microaggressions and how they manifest. Give common examples, and explain how even well-intentioned statements might mask bias and be offensive to other individuals.
• Ask employees to play an active role in identifying microaggressions, and empower them to work together to find solutions. Use real-life, de-identified scenarios provided by employees as training examples.
• Train employees on constructive communications strategies for responding to microaggressions, and empower both targets and bystanders to do their part to combat these behaviors.
• Offer information and education about microaggressions in various formats to help engage employees who have differing learning styles and who might feel more comfortable discussing sensitive topics in certain contexts (e.g., small group discussions vs. large groups).
• Solicit employee feedback on your organization’s culture through periodic surveys, discussion forums, team meetings, etc. Make sure a mechanism is in place that allows staff members to provide anonymous feedback and report microaggressions.
• Reassure employees that their concerns will be taken seriously. Establish consistent and transparent processes for investigating, documenting, and following up on complaints about microaggressions.
• Review your organization’s code of conduct to verify that it includes microaggressions in its definitions of unacceptable and inappropriate behavior. Make employees aware of disciplinary actions that might ensue if these behaviors continue after an initial warning.⁵

In Summary

Microaggressions are an unfortunate aspect of an overarching problem with bias in society. Although these comments, behaviors, and actions might appear small or insignificant, they can be quite harmful when viewed through a cumulative lens.

In healthcare organizations, microaggressions cause negative consequences for individuals, for departments, for the workforce as a whole, and for the institution. Addressing microaggressions as part of an overall strategy to confront and mitigate bias can help healthcare organizations cultivate and support diverse and inclusive workplace cultures.

More Resources

For more information related to organizational culture and bias, see MedPro’s articles Confronting Implicit Bias in Healthcare: Strategies for Clinicians and Is Your Culture of Safety Psychologically Safe?

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¹ Baker College. (2021, February 23). Examples of workplace microaggressions and how to reduce them. Retrieved from www.baker.edu/about/get-to-know-us/blog/examples-of-workplace-microaggressions-and-how-to-reduce-them/; Culture Amp. (n.d.). Microaggressions at work: Recognizing & overcoming our biases. Retrieved from https://www.cultureamp.com/blog/microaggressions-at-work; Smith, A. (2022, March 9). What to know about microaggressions. Medical News Today. Retrieved from www.medicalnewstoday.com/articles/microagressions

² Washington, E. F. (2022, May 10). Recognizing and responding to microaggressions at work. Harvard Business Review. Retrieved from https://hbr.org/2022/05/recognizing-and-responding-to-microaggressions-at-work

³ Ehie, O., Muse, I., Hill, L., & Bastien, A. (2021). Professionalism: Microaggression in the healthcare setting. Current Opinion in Anaesthesiology, 34(2), 131–136. https://doi.org/10.1097/ACO.0000000000000966

⁴ Chiappetta, C. (2022, February 14). Combatting microaggressions in the workplace. HRCI Learning Center. Retrieved from www.hrci.org/community/blogs-and-announcements/hr-leads-business-blog/hr-leads-business/2022/02/14/combating-microaggressions-in-the-workplace

⁵ Ibid; Ehie, et al., Professionalism: Microaggression in the healthcare setting; Acholonu, R. G., Cook, T. E., Roswell, R. O., & Greene, R. E. (2020). Interrupting microaggressions in health care settings: A guide for teaching medical students. MedEdPORTAL, 16, 10969. https://doi.org/10.15766/mep_2374-8265.10969

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