Equity Learning Reports

July 31, 2020

I’m going to go out on a limb and surmise that John Lewis would say that we should approach racial justice and equity the same way we approach catheter-associated bloodstream infections.

The connection may seem tenuous, but hear me out.  Traditionally, safety in healthcare was seen as an issue of “medical error.” The focus was on “mistakes” by individuals as the root of the problem, and disciplinary action as the solution.  In that kind of culture, people who had concerns about safety issues in the hospital either kept quiet for fear of being labeled a troublemaker, or they filed an “incident report,” which was used most often to punish someone for making an “error.”

Today, safety is seen as a system issue.  People with concerns are encouraged to file “safety learning reports,” with an effort to identify the system factors that allow harm events to occur, rather than finding bad actors to blame.  Speaking up is no longer frowned upon; reporting is not labeled as troublemaking.  And preventing harm is not a divisive effort to affix blame, but a collective effort to fix the system.

Similarly, racism is being seen not as a personal failing by some individuals, but as a set of customs, practices, and laws that have had the effect of advantaging some groups over others.  Justice then is not an effort to call out and punish guilty individuals, but a collective effort by all to create a system that works for all.

Unfortunately, too often we continue to view racial justice solely through the lens of individual action and accountability.  As a result, calling out examples of inequity is seen as troublemaking and divisive.  Protest is viewed as the equivalent of filing an incident report, rather than an opportunity to learn and improve.

John Lewis, who recently died, was a long-term congressman from Georgia and civil rights icon.  He was also an apostle for non-violence.  Trained and ordained as a Baptist minister, he was a co-founder of the Student Non-Violent Coordinating Committee, one of the original Freedom Riders, and a student of both Gandhi and King.  He was both an advocate for and a practitioner of peaceful protest.

I’ve often wondered about the inherent tension in the phrase “peaceful protest.”  Protest, after all, implies discontent with a state of affairs, opposition to something.  Opposition in turn implies conflict, which seems to be the opposite of peace.  But discontent is the impetus for improvement, for change.  As long as things are less than perfect, there will be discontent – appropriately so.  We know that racial inequity is an important factor affecting the health of the children we serve.  We should be discontent.  And as long as we are discontent with the current state, as long as we seek to improve it, we will have conflict.

The error is in thinking that conflict is the opposite of peace.  As C.T. Butler, founder of Food Not Bombs, says, “peace is not the absence of conflict, but rather, the ability to resolve conflict without violence.”  If discontent is the impetus for change, conflict is the path to achieving that change.  Without conflict, there is no progress.  The trick is in engaging in conflict productively to produce that change.   Any collection of more than one person – a family, an organization, a community – will have conflict, as it seeks to improve and maximize the happiness and well-being of all.  Welcoming the airing of differences and having ways of resolving those differences amicably makes for stronger and healthier families, organizations, and communities.

It has been said you can’t improve what you can’t measure.  It’s at least as true that you can’t improve what you’re not even aware of.  If my spouse doesn’t tell me that something I am doing is annoying or hurtful, I can’t change it. If a nurse doesn’t report a mislabeled medication or a near-miss wrong-site procedure, we can’t design the system better to prevent such events.  If a marginalized group doesn’t make the dominant group aware of the ways the system works against them, we can’t make the system more just and equitable.  Protest is the equivalent of “if you see something, say something.”  It’s the safety learning report for society.

My hope is that we will stop viewing protest as an effort to divide, but rather as an effort to unite us in the journey toward equity and justice.  One of the ways I think the current moment is different is the increased willingness to see such peaceful protest as a necessary constructive step toward equity.  We are starting to listen, really listen, to the concerns of many in our community.  We must then join together to take action.

I don’t know if John Lewis would know a CLABSI from a PIVIE.  But he certainly understood the idea of peaceful protest and loving engagement as a way to help bend that arc of the moral universe a little closer toward justice:

“We must never ever give up, or give in or throw in the towel. We must continue to press on! And be prepared to do what we can to help educate people, to motivate people, to inspire people to stay engaged, to stay involved and to not lose their sense of hope. We must continue to say we’re one people. We’re one family. We all live in the same house. Not just an American house but the world house. As Dr. King said over and over again, ‘We must learn to live together as brothers and sisters. If not, we will perish as fools.’”


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