October is National Disability Awareness Month – and of all the “awareness months,” this is one subject that needs more sunlight. Which is odd, considering how many of us live with some kind of disability – 27% or more than 1 in 4 people. Even those of us who don’t currently live with a disabling condition could acquire one at any point in our lives. Disability – neurological, cognitive, mobility, hearing and vision or other type – is a category that any of us could join in the future.
And it’s a category many patients and providers have already joined – yet somehow disability isn’t much of a conversation in healthcare. Given how common disabilities are, why do people get so uncomfortable talking about them? And how can we be more inclusive in healthcare for both patients and providers with disabilities?
Disabilities in the Workplace
When we talk about disabilities, people often picture a wheelchair or service dog or prosthesis. But a disability like a chronic illness or learning disability can be invisible while still requiring accommodations in the workplace.
It’s at this intersection that the definition of disability can go fuzzy. Some people draw a line between a condition and a disability, defining the impact of that condition as the disability. Consider the debate on whether neurodiversity is a disability or simply a variation in human brain function. Experiencing the world differently is not a disability in itself – but the challenges that come from living in a world designed for neurotypical processing can present hardships.
In the Center for Talent Innovation’s “Disabilities and Inclusion” study, 30% of the professional workforce fit the current federal definition of having a disability — and most of them kept it to themselves. Only 39% of employees with disabilities disclosed to their manager, while only 24% informed their teams.
Why would a disability be a secret? Consider the experience of Robin, an accounts payable manager.
“I worked at a place where my cubicle was under a bright light that hissed and rattled off and on all day,” Robin said. “I couldn’t concentrate. I didn’t want anyone to know I was HFA <high functioning autism> but I finally had to ask to move my cubicle and tell them why. Afterward, I felt like everyone walked on eggshells around me.”
This is why so many people don’t want to disclose. Too many people see disability as a synonym for deficit. They might even exude a whiff of pity or subtle blame when acknowledging someone’s disability; they might assume limitations that don’t exist or forget limitations that do.
It should be different in healthcare, of course. Clinical environments are supposed to be driven by insight and humanitarian compassion. But both patients and providers report a different experience.
Disabilities in Healthcare
Barriers to care abound for many populations; we talk about it all the time on this blog. So what does care look like for people with disabilities? According to the CDC:
- 1 in 4 adults with disabilities are going without treatment for a medical condition due to cost
- 1 in 5 haven’t visited a doctor in the last year
- Adults with disabilities are more likely to experience obesity, heart disease, diabetes, and tobacco use.
This isn’t surprising when you consider that people with disabilities may not be able to drive to a healthcare appointment; they may be on a limited income. In healthcare encounters, some may have difficulty communicating their issues, leading to misdiagnosis or inadequate treatment plans. Their providers may not know the correct questions to ask.
But let’s flip the script. Imagine now it’s the provider who’s disabled. A JAMA study found that roughly 3% of physicians have a disability. The most common category was chronic health conditions, followed by mobility impairments, then psychological impairments. Other categories included hearing and vision impairments, autism, adult attention-deficit/hyperactivity disorder, and learning disabilities.
Our hypothetical provider has the skills to contribute significantly to patient outcomes and hospital culture. But will they get the chance? If their disability is obvious, assumptions about their capabilities can block their hiring. A lack of accessible workstations or scheduling flexibility can make it tough to succeed. Their colleagues may treat them differently or fail to trust them with complex patient cases.
Celebrating Differences in Healthcare
In an ideal world, disability would be recognized as another valuable experience that can enrich a hospital staff’s diversity. But too often, DEI programs have ignored the clinicians and administrators with disabilities who struggle to access and succeed in their workplaces.
If you’d like to improve your hospital’s approach to disability, here are a few places to start:
- Don’t treat disability as a shameful thing. The CTI study found that employees who feel safe disclosing at work are more than twice as likely to feel content at work than employees with disabilities who have not disclosed. They are also less likely to feel isolated or anxious.
- Acknowledge your colleague as a person – not as their disability. Someone is more than their blindness or dyslexia. If you became disabled this year, would you become less of a person than you already are? Of course not.
- Implement training on treating patients with disabilities. Take a look at your current training ecosystem. Does it include curriculum on improving the patient experience for patients with disabilities?
- Be respectful with language. It’s accepted practice to use people-first language: “person with disability” vs. “disabled person” or “handicapped person,” which can feel dehumanizing.
- But don’t try to erase the disability either. Many people think saying, “I don’t see you as disabled” is positive but that frames the disability as a negative.
- Don’t make assumptions. Sondra, an amputee, stunned her coworkers when she announced her pregnancy. One blurted out, “It’s not safe for you to have a baby!” Biases and misconceptions abound when it comes to disability. It’s always better to ask questions or educate ourselves.
- Find ways to implement inclusive hiring and retention practices. That might include offering information on accommodation requests before someone asks or showing support on your website and during the application and onboarding processes.
- Consider starting an Employee Resource Group (ERG) in your hospital for employees with disabilities. Events, task forces, and online channels can create an empathetic community to support workers. Confidentiality should be guaranteed for employees who aren’t ready to disclose to their team, of course.
A more inclusive healthcare workforce is good for staff and patients. From attending school to interviewing for a job to seeing a doctor, people with disabilities often spend valuable energy adapting to systems and practices that weren’t built for them. Now it’s healthcare’s turn to adapt to their needs and learn from their perspectives. Building a more comfortable and diverse healthcare world means a world that is actually healthier for everyone.
Tribal Health is committed to creating a workplace and environment where all individuals, regardless of ability or disability, have equitable access and opportunities for success.
