Power imbalance in health care reveals impact of race and role on team dynamics and DEI efforts

Background and Goal: Team-based care is considered the gold standard in delivery models. It uses integrated clinical teams with diverse skills and perspectives to provide efficient, high-quality health care services. Within these teams, individuals from minoritized racial-ethnic groups, often referred to as persons of color (POC), typically occupy roles with less authority (e.g., medical assistants), while white individuals more frequently hold positions of greater power (e.g., physicians). Few studies have explored the viewpoints of staff members in lower-power roles, who are disproportionately POC and constitute the majority of a health care team. This study aims to understand the perspectives of clinic staff members across racial and role groups to inform future interventions that could improve health care teams and address race-related issues more effectively.

Study Approach: From May to July 2021, researchers conducted semi-structured, 45-minute interviews with 60 staff members at community health clinics within a large urban health care system. The team intentionally recruited participants to ensure representation of POC and support staff, including medical assistants, front desk clerks, care navigators, nurses, and others. Interviews were recorded, transcribed, and analyzed over six months using a critical ideological framework. This theoretical approach focuses on understanding and challenging power structures, ideologies, and social inequalities within society.

Main Results: Among the 60 participants, most identified as female (83%), POC (68%), and support staff (70%). Five overarching themes emerged:

• POC face hidden challenges
• Racial discrimination persists
• Power dynamics perpetuate inaction
• Interpersonal actions (such as relationship building, active recognition of staff member contributions, and tangible anti-racist steps) foster safety and equity
• System-level change is needed for cultural shifts

POC team members deal with hidden challenges related to managing an emotional burden that white team members may not perceive. Those with the least power in the clinic, namely support staff who are POC, bear the brunt of this burden and yet have the least power to effect change, resulting in diversity, equity, and inclusion (DEI) inaction. Relationship building acts as a buffer to race-related experiences and is, to some extent, reparative and protective for POC team members.

Why It Matters: Without a sense of belonging and value, diversity and equity efforts fail to last in the workplace. Interpersonal actions and system-level changes are essential for a cultural shift, undertaken by those currently in positions of power. The findings show that investing time in developing team relationships, actively recognizing staff contributions, and taking tangible antiracist actions by leadership foster safety and equity. The researchers recommend that leadership take on the responsibility of identifying and offering repeated, experiential, and interactive training. These should serve as alternatives to ineffective one-time DEI training.

Power Dynamics Perpetuate DEI Inaction: A Qualitative Study of Community Health Clinic Teams

Laura Marie Ramzy, PhD, et al 

Integrated Behavioral Health, Ambulatory Care Services, Denver Health and Hospital Authority,

Denver, Colorado

Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado

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